Provider Demographics
NPI:1992903009
Name:FERNANDEZ, MARY MAE B (PT)
Entity type:Individual
Prefix:
First Name:MARY MAE
Middle Name:B
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:7901 CUMBERLAND PARK DR
Mailing Address - Street 2:8104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-5426
Mailing Address - Country:US
Mailing Address - Phone:321-442-4388
Mailing Address - Fax:407-970-0924
Practice Address - Street 1:7350 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE 2212
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8040
Practice Address - Country:US
Practice Address - Phone:401-363-9668
Practice Address - Fax:407-970-0924
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2010-06-09
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Provider Licenses
StateLicense IDTaxonomies
FLPT23008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist