| Matthew Vidal Fernandez, PT | |
|
505 N Main Ave, Aztec, NM 87410-1942 | |
| (505) 334-9616 | |
| Not Available |
| Full Name | Matthew Vidal Fernandez |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist |
| Location | 505 N Main Ave, Aztec, New Mexico |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851001077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT22009 (New Mexico) | Primary |
| Provider Name | Physical Therapy & Sports Medicine Of Northern New Mexico, Inc. |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1306069224 PECOS PAC ID: 1951401785 Enrollment ID: O20070710000300 |
| Mailing Address | Practice Location Address |
|---|---|
| Matthew Vidal Fernandez, PT 2201 N Tucker Ave Apt 1, Farmington, NM 87401-8960 Ph: () - | Matthew Vidal Fernandez, PT 505 N Main Ave, Aztec, NM 87410-1942 Ph: (505) 334-9616 |
Margaret Irene Gores, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 505 N Main Ave, Aztec, NM 87410 Phone: 505-334-9616 Fax: 505-334-7343 | |
Gordon Henriksen, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1607 W Aztec Blvd, Aztec, NM 87410 Phone: 505-334-3695 | |
Mr. Sid Mosiman, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 505 N Main Ave, Aztec, NM 87410 Phone: 505-334-9616 Fax: 505-334-7343 |