Provider Demographics
NPI:1780960344
Name:FERNANDO PHYSICAL THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:FERNANDO PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, PHD, MDT
Authorized Official - Phone:772-223-4563
Mailing Address - Street 1:421 SE OSCEOLA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2505
Mailing Address - Country:US
Mailing Address - Phone:772-223-4563
Mailing Address - Fax:772-223-4567
Practice Address - Street 1:421 SE OSCEOLA ST
Practice Address - Street 2:SUITE C
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2505
Practice Address - Country:US
Practice Address - Phone:772-223-4563
Practice Address - Fax:772-223-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6978174400000X, 251E00000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FU360AMedicare PIN