MEDICARE: MARY MAE B 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	PT23008	FL

General Provider Information

NPI Number	:	1992903009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MAE B FERNANDEZ PT

Provider Business Mailing Address
First Line	:	7901 CUMBERLAND PARK DR
Second Line	:	8104
City	:	ORLANDO
State	:	FL
Zip	:	32821-5426
Country	:	US
Telephone Number	:	321-442-4388
Fax Number	:	407-970-0924

Provider Business Practice Location Address
First Line	:	7350 SANDLAKE COMMONS BLVD
Second Line	:	SUITE 2212
City	:	ORLANDO
State	:	FL
Zip	:	32819-8040
Country	:	US
Telephone Number	:	401-363-9668
Fax Number	:	407-970-0924

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	06/09/2010

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