Provider Demographics
NPI:1689943201
Name:FRIAS FUENTES, FANELIS (PT)
Entity type:Individual
Prefix:MRS
First Name:FANELIS
Middle Name:
Last Name:FRIAS FUENTES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503 N MILITARY TRL
Mailing Address - Street 2:#3211
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2698
Mailing Address - Country:US
Mailing Address - Phone:561-218-4123
Mailing Address - Fax:
Practice Address - Street 1:6503 N MILITARY TRL
Practice Address - Street 2:#3211
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2698
Practice Address - Country:US
Practice Address - Phone:561-218-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist