Provider Demographics
NPI:1043866031
Name:FLEDDERJOHN, BRET CURTIS
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:CURTIS
Last Name:FLEDDERJOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-2620
Mailing Address - Country:US
Mailing Address - Phone:717-254-0775
Mailing Address - Fax:
Practice Address - Street 1:4002 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-2620
Practice Address - Country:US
Practice Address - Phone:717-254-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer