Provider Demographics
NPI:1881966067
Name:FERNANDEZ, LISA (DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1080 99TH ST APT 221
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1754
Mailing Address - Country:US
Mailing Address - Phone:305-467-9421
Mailing Address - Fax:
Practice Address - Street 1:4801 S UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3835
Practice Address - Country:US
Practice Address - Phone:786-259-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist