Healthcare Provider Details

I. General information

NPI: 1629519699
Provider Name (Legal Business Name): KAREN FERNANDEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 02/25/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 RAYMOND DR
NORTHBROOK IL
60062-6715
US

IV. Provider business mailing address

1942 RAYMOND DR
NORTHBROOK IL
60062-6715
US

V. Phone/Fax

Practice location:
  • Phone: 630-447-9746
  • Fax: 630-385-0124
Mailing address:
  • Phone: 630-447-9746
  • Fax: 773-337-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070022351
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: