Individual
JOAN FERNANDEZ TOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
6970 FOX HUNT LN, GLOUCESTER, VA 23061-5394
(804) 694-8111
(804) 694-5574
Mailing address
PO BOX 69030, BALTIMORE, MD 21264-9030
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305209459
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801275060
MEDICAID QMB
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
05/21/2015
Last updated
05/04/2018
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