Provider Demographics
NPI:1528892809
Name:FERNANDEZ, SIERRA D (DPT)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:D
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-0288
Mailing Address - Country:US
Mailing Address - Phone:808-632-0033
Mailing Address - Fax:808-632-0077
Practice Address - Street 1:PO BOX 288
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-0288
Practice Address - Country:US
Practice Address - Phone:808-632-0033
Practice Address - Fax:808-632-0077
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist