Basic Information
| Provider Information | |||||||||
| NPI: | 1548650260 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FEDLER | ||||||||
| FirstName: | SARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1932 225TH AVE | ||||||||
| Address2: | |||||||||
| City: | WEST POINT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526569355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3194709310 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 VILLAGE CIR | ||||||||
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| City: | KEOKUK | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526322040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3195245772 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2015 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 075073 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.