Individual
GREG FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2225 WISCONSIN AVE STE 100, GRAFTON, WI 53024-2608
(262) 474-0063
(262) 222-6281
Mailing address
N69W5289 COLUMBIA RD, CEDARBURG, WI 53012-2156
(262) 546-4696
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11288
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215481148
—
WI
Enumeration date
08/09/2016
Last updated
09/27/2022
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