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NPI Code Detail

MEDICARE: MR. MARK FERNANDEZ P.T.

MEDICARE: MR. MARK FERNANDEZ P.T.
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
1225100000XPhysical TherapistPT001459OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CM0529OTHEROHMEDICARE ID TYPE UNSPEC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508828500
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK FERNANDEZ P.T.
Provider Business Mailing Address
First Line : 3244 BAILEY ST NW
Second Line :
City : MASSILLON
State : OH
Zip : 44646-3616
Country : US
Telephone Number : 330-833-3110
Fax Number : 330-833-3115
Provider Business Practice Location Address
First Line : 3244 BAILEY ST NW
Second Line :
City : MASSILLON
State : OH
Zip : 44646-3616
Country : US
Telephone Number : 330-833-3110
Fax Number : 330-833-3115
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 10/15/2008

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Directions to “ MR. MARK FERNANDEZ P.T.” Practice Location

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