Provider Demographics
NPI:1528669942
Name:FERNANDEZ, LORENZO ANTONIO (PTA)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:ANTONIO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 WELHAM ST APT 437
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6855
Mailing Address - Country:US
Mailing Address - Phone:786-474-5650
Mailing Address - Fax:
Practice Address - Street 1:558 N SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2840
Practice Address - Country:US
Practice Address - Phone:407-679-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA30424225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant