MEDICARE: JUSTIN M FEDIE 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
1	225100000X	Physical Therapist	10260024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0604410001	OTHER	WI	DMERC

General Provider Information

NPI Number	:	1699705962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN M FEDIE PT

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8813
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	555 E TOWNLINE RD STE 24
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1552
Country	:	US
Telephone Number	:	847-573-0051
Fax Number	:	847-573-0345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/21/2022

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Directions to “ JUSTIN M FEDIE PT” Practice Location

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