John Michael Agsao Fernandez, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160008094 Issued in IL

Practice address

2655 W Peterson Ave # 60659
Chicago, IL 60659-4017

Phone

(224) 715-6741

NPI assigned

Dec 17, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1922767904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 W PETERSON AVE # 60659",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594017",
            "telephone_number": "224-715-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "JOHN MICHAEL",
        "middle_name": "AGSAO",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-17",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160008094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Fernandez
• Gary Ray Fernandez, M.D.
• Jadee Fernandez
• Javier Fernandez
• John J. Fernandez, M.D.
• Jose R Fernandez
• Katherine Fernandez, DPT
• Katherine G Fernandez
• Katia Fernandez
• Kimberly Michelle Fernandez, MD

• Physical Therapy Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.