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NPI Code Detail

MEDICARE: MISS KATHLEEN JEANNE FERNANDEZ PTA

MEDICARE: MISS KATHLEEN JEANNE FERNANDEZ PTA
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
1225200000XPhysical Therapy AssistantA910MN

General Provider Information

NPI Number : 1295981405
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KATHLEEN JEANNE FERNANDEZ PTA
Provider Business Mailing Address
First Line : 312 HORSETHIEF TRL
Second Line :
City : MANCHACA
State : TX
Zip : 78652-4732
Country : US
Telephone Number : 512-573-0916
Fax Number :
Provider Business Practice Location Address
First Line : 611 W MAIN ST
Second Line :
City : BELLE PLAINE
State : MN
Zip : 56011-1221
Country : US
Telephone Number : 952-873-2219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2008
Last Update Date : 08/07/2008

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Directions to “ MISS KATHLEEN JEANNE FERNANDEZ PTA” Practice Location

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