MEDICARE: ANTHONY FERNANDEZ PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	25271	NY

General Provider Information

NPI Number	:	1255665808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY FERNANDEZ PT

Provider Business Mailing Address
First Line	:	3960 54TH ST APT 4A
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-4209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 ASTORIA BLVD
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1138
Country	:	US
Telephone Number	:	718-888-6920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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