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NPI Code Detail

MEDICARE: MRS. MONICA J FIEDLER P.T.

MEDICARE: MRS. MONICA J FIEDLER P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical Therapist070-009839IL

General Provider Information

NPI Number : 1265443923
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MONICA J FIEDLER P.T.
Provider Business Mailing Address
First Line : 4701 N OAK ST
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60012-3309
Country : US
Telephone Number : 815-788-1020
Fax Number : 815-788-1422
Provider Business Practice Location Address
First Line : 4701 N OAK ST
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60012-3309
Country : US
Telephone Number : 815-788-1020
Fax Number : 815-788-1422
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 04/02/2020

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