Individual
LEO FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 HALL PLACE, MILFORD, DE 19963
(302) 396-0473
Mailing address
300 HALL PL, MILFORD, DE 19963-1809
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J1-0002543
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J1-0002543
PT LICENSE
DE
Enumeration date
06/08/2017
Last updated
07/10/2021
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