Individual
ERICA FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT., MS
Contact information
Practice address
291 W CENTRE AVE, PORTAGE, MI 49024-5353
(269) 382-8489
Mailing address
291 W CENTRE AVE, PORTAGE, MI 49024-5353
(269) 382-8489
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
25894
MD
225100000X
Physical Therapist
Primary
5501017168
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447657507
NPI TYPE 2/ ORGANIZATION NPI
MD
05
—
4374045-00
—
MD
Enumeration date
12/21/2016
Last updated
10/11/2019
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