| Doctor Name: | LARIZA MAE FERNANDO |
| NPI Number: | 1801267968 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 006711 |
| Business Practice Address: | 26901 Us Hwy 119 S Tug Valley Arh Belfry, KY - 41514 |
| Business Phone Number: | 6062371460 |
| Business Fax Number: | |
| Mailing Address: | 132 W 4th Ave, WILLIAMSON |
| State: | WV |
| Postal Code: | 256613112 |
| Phone Number: | 6062371460 |
| Fax Number: | |
| NPI Enumeration Date: | 10/15/2015 |
| NPI Last Update Date: | 10/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 006711 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |