Individual
LARIZA MAE FERNANDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
26901 US HWY 119 S, TUG VALLEY ARH, BELFRY, KY 41514
(606) 237-1460
Mailing address
132 W 4TH AVE, WILLIAMSON, WV 25661-3112
(606) 237-1460
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006711
KY
Other
Enumeration date
10/15/2015
Last updated
10/15/2015
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