Healthcare Provider Details

I. General information

NPI: 1295692135
Provider Name (Legal Business Name): GABRIEL A FERNANDEZ PTA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S NEEDLES HWY STE 500
LAUGHLIN NV
89029-0815
US

IV. Provider business mailing address

746 E WINCHESTER ST STE 200
MURRAY UT
84107-8513
US

V. Phone/Fax

Practice location:
  • Phone: 702-868-1400
  • Fax:
Mailing address:
  • Phone: 801-485-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-010808
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: