Healthcare Provider Details

I. General information

NPI: 1780960344
Provider Name (Legal Business Name): FERNANDO PHYSICAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SE OSCEOLA ST SUITE C
STUART FL
34994-2505
US

IV. Provider business mailing address

421 SE OSCEOLA ST SUITE C
STUART FL
34994-2505
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-4563
  • Fax: 772-223-4567
Mailing address:
  • Phone: 772-223-4563
  • Fax: 772-223-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT6978
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPT6978
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO FIGUEROA
Title or Position: PRESIDENT
Credential: PT, DPT, PH.D., MDT
Phone: 772-223-4563