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NPI Code Detail

MEDICARE: NIDEO FOSTER DPT, PT

MEDICARE: NIDEO FOSTER DPT, PT
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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316675150
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIDEO FOSTER DPT, PT
Provider Business Mailing Address
First Line : 4939 WISTERIA LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1741
Country : US
Telephone Number : 260-446-1630
Fax Number :
Provider Business Practice Location Address
First Line : 3731 W COOK RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-9662
Country : US
Telephone Number : 260-215-4490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2022
Last Update Date : 10/18/2022

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