Provider Demographics
NPI:1861388415
Name:FERNANDEZ, PEDRO MANUEL (LMT)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:MANUEL
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 N 300 E # 745
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1215
Mailing Address - Country:US
Mailing Address - Phone:435-695-6332
Mailing Address - Fax:
Practice Address - Street 1:921 E EXECUTIVE PARK DR STE C
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-3549
Practice Address - Country:US
Practice Address - Phone:385-831-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14030890-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty