Provider Demographics
NPI:1952467854
Name:FERNANDEZ, RONALD O (PT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:O
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6362
Mailing Address - Country:US
Mailing Address - Phone:972-270-5555
Mailing Address - Fax:972-270-7071
Practice Address - Street 1:2696 N GALLOWAY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6362
Practice Address - Country:US
Practice Address - Phone:972-270-5555
Practice Address - Fax:972-270-7071
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D0308Medicare ID - Type Unspecified