MEDICARE: JULIE 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	109324	MO

General Provider Information

NPI Number	:	1548229321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE FERNANDEZ PT

Provider Business Mailing Address
First Line	:	4800 MEXICO RD
Second Line	:	SUITE 104
City	:	ST PETERS
State	:	MO
Zip	:	63376-1666
Country	:	US
Telephone Number	:	636-928-4199
Fax Number	:	636-922-0818

Provider Business Practice Location Address
First Line	:	4800 MEXICO RD
Second Line	:	SUITE 104
City	:	ST PETERS
State	:	MO
Zip	:	63376-1666
Country	:	US
Telephone Number	:	636-928-4199
Fax Number	:	636-922-0818

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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