Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA28705 | FL |
NPI | 1003399528 |
---|---|
Provider Name | Karina Ines Fernandez |
First Address | Hialeah, FL 33018-5225 |
Second Address | Pembroke Pines, FL 33025-1723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2018 |
Last Update Date | 11/09/2018 |