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General NPI Number Information
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NPI Number | 1851903256
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Entity Type | Individual
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Provider Name | JOHN H FIDLER III DPT
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Gender | Male
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 633 MIDDLESEX TPKE
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-1220
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Country | US
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Telephone | 203-688-6993
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Fax |
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Provider Business Mailing Address
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Address Line | 47 DENLER DR
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1324
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Country | US
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Telephone | 860-214-8649
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 011106
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License Number State | CT
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