Provider Demographics
NPI:1174504963
Name:FIDLER, ERIN E (LPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:FIDLER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:Q
Other - Last Name:EGGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:4130 DUTCHMANS LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4713
Mailing Address - Country:US
Mailing Address - Phone:502-897-1794
Mailing Address - Fax:502-897-0093
Practice Address - Street 1:4130 DUTCHMANS LN
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4713
Practice Address - Country:US
Practice Address - Phone:502-897-1794
Practice Address - Fax:502-897-0093
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT004835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100144310Medicaid
KY7100144310Medicaid
KYP400030156Medicare PIN