Healthcare Provider Details

I. General information

NPI: 1679681316
Provider Name (Legal Business Name): CAROLE LYNN FELLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 STEIN AVE
MADISON WI
53714-1731
US

IV. Provider business mailing address

4525 STEIN AVE
MADISON WI
53714-1731
US

V. Phone/Fax

Practice location:
  • Phone: 608-438-8717
  • Fax: 608-242-9576
Mailing address:
  • Phone: 608-438-8717
  • Fax: 608-242-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5952-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: