Provider Demographics
NPI:1629956347
Name:FERNANDEZ, IRENE ALEXANDRA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:ALEXANDRA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1949
Mailing Address - Country:US
Mailing Address - Phone:863-812-2671
Mailing Address - Fax:
Practice Address - Street 1:10000 W COLONIAL DR STE 381
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3435
Practice Address - Country:US
Practice Address - Phone:407-296-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT43423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist