Individual
MS. LISA M FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1375 S COTTERELL WAY, BOISE, ID 83709-1504
(208) 378-9194
Mailing address
1375 S COTTERELL WAY, BOISE, ID 83709-1504
(208) 378-9194
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
040-0001077
VT
225100000X
Physical Therapist
Primary
RPT-514
ID
Other
Enumeration date
01/29/2007
Last updated
07/08/2007
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