Provider Demographics
NPI:1699913673
Name:FERNANDEZ, KEIKO (DPT)
Entity type:Individual
Prefix:DR
First Name:KEIKO
Middle Name:
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 1:1800 SW 1ST AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1181
Mailing Address - Country:US
Mailing Address - Phone:786-399-4453
Mailing Address - Fax:888-368-4883
Practice Address - Street 1:1800 SW 1ST AVE STE 502
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-1181
Practice Address - Country:US
Practice Address - Phone:786-399-4453
Practice Address - Fax:888-368-4883
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0291752251P0200X, 2251S0007X, 2251X0800X
FL258232251S0007X, 2251X0800X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF655500817220OtherDRIVERS LISENCE