Healthcare Provider Details

I. General information

NPI: 1609505122
Provider Name (Legal Business Name): THOMAS FETTER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 ELM DR
WAYNESBURG PA
15370-8275
US

IV. Provider business mailing address

249 ELM DR
WAYNESBURG PA
15370-8275
US

V. Phone/Fax

Practice location:
  • Phone: 724-825-9357
  • Fax: 724-270-3011
Mailing address:
  • Phone: 724-825-9357
  • Fax: 724-270-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: