Individual
BENJAMIN COREY FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C-AA, DPT
Contact information
Practice address
1225 AIRPORT RD, DESTIN, FL 32541-2909
(850) 650-7606
(850) 337-1698
Mailing address
1225 AIRPORT RD, DESTIN, FL 32541-2909
(850) 650-7606
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT27491
FL
367H00000X
Anesthesiologist Assistant
Primary
AA472
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101045800
—
FL
01
—
P01240342
RAILROAD MEDICARE
—
01
—
Y0CP4
BCBS
FL
Enumeration date
07/25/2012
Last updated
01/20/2021
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