Healthcare Provider Details

I. General information

NPI: 1598208670
Provider Name (Legal Business Name): RICHARD JOSEPH FERNANDEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 AUTO CLUB DR STE 150
DEARBORN MI
48126-2779
US

IV. Provider business mailing address

8030 AGNES ST
DETROIT MI
48214-2619
US

V. Phone/Fax

Practice location:
  • Phone: 313-982-8266
  • Fax: 313-982-8098
Mailing address:
  • Phone: 419-345-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016016
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: