Provider Demographics
NPI:1033442413
Name:FERN, GEORGE ALBERT (DPT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALBERT
Last Name:FERN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 W WARNER RD
Mailing Address - Street 2:A-2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2713
Mailing Address - Country:US
Mailing Address - Phone:480-821-2286
Mailing Address - Fax:480-899-9789
Practice Address - Street 1:1257 W WARNER RD
Practice Address - Street 2:A-2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2713
Practice Address - Country:US
Practice Address - Phone:480-821-2286
Practice Address - Fax:480-899-9789
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist