Provider Demographics
NPI:1306082292
Name:FERNANDEZ, DARIO (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:DARIO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 KNIBBE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2732
Mailing Address - Country:US
Mailing Address - Phone:512-940-3745
Mailing Address - Fax:
Practice Address - Street 1:302 E JOSEPHINE ST STE 1101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215
Practice Address - Country:US
Practice Address - Phone:214-965-0431
Practice Address - Fax:214-965-0434
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12988122251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183477202Medicaid
TX454880Medicare Oscar/Certification