MEDICARE: MRS. MEREDITH ANN FESS DPT

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	PTO-16391	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00692852	OTHER	PA	RAILROAD MEDICARE

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	2297301000	OTHER	PA	IBC
4	11779874	OTHER	PA	KEYSTONE MERCY
5	1619596	OTHER	PA	HIGHMARK PABS
6	30060798	OTHER	PA	KEYSTONE MERCY

General Provider Information

NPI Number	:	1790715902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEREDITH ANN FESS DPT

Provider Business Mailing Address
First Line	:	2 W 10TH ST
Second Line	:
City	:	MARCUS HOOK
State	:	PA
Zip	:	19061-4513
Country	:	US
Telephone Number	:	610-859-8850
Fax Number	:	610-859-7876

Provider Business Practice Location Address
First Line	:	3501 MASONS MILL RD
Second Line	:	SUITE 501
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-3517
Country	:	US
Telephone Number	:	215-659-8600
Fax Number	:	215-659-4498

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	11/04/2010

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