Healthcare Provider Details

I. General information

NPI: 1275719619
Provider Name (Legal Business Name): JULIE ANN FIDLER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 AMHERST ST SNHRC
NASHUA NH
03063-1220
US

IV. Provider business mailing address

460 AMHERST ST SNHRC
NASHUA NH
03063-1220
US

V. Phone/Fax

Practice location:
  • Phone: 603-595-0230
  • Fax:
Mailing address:
  • Phone: 603-595-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNH2375
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number109981
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009909-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: