Provider Demographics
NPI:1386050797
Name:FERNANDEZ, LAYSA (ATC)
Entity type:Individual
Prefix:
First Name:LAYSA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 SW 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3702
Mailing Address - Country:US
Mailing Address - Phone:305-923-9886
Mailing Address - Fax:786-268-9978
Practice Address - Street 1:3240 SW 104TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3702
Practice Address - Country:US
Practice Address - Phone:305-923-9886
Practice Address - Fax:786-268-9978
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL37542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer