Healthcare Provider Details

I. General information

NPI: 1932829710
Provider Name (Legal Business Name): EMMELY OVALLE-FERNANDEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMELY OVALLE PEREZ

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 DENTON AVE
HUDSON FL
34667-5419
US

IV. Provider business mailing address

17513 HANNA RD
LUTZ FL
33549-5670
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-9101
  • Fax:
Mailing address:
  • Phone: 813-513-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: