Provider Demographics
NPI:1750601167
Name:FERNANDEZ, OSCAR R (PT)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:R
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8142 S STATE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3210
Mailing Address - Country:US
Mailing Address - Phone:801-708-9226
Mailing Address - Fax:877-822-8366
Practice Address - Street 1:8142 S STATE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3210
Practice Address - Country:US
Practice Address - Phone:801-708-9226
Practice Address - Fax:877-822-8366
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119141-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist