Provider Demographics
NPI:1265443923
Name:FIEDLER, MONICA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:J
Last Name:FIEDLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3309
Mailing Address - Country:US
Mailing Address - Phone:815-788-1020
Mailing Address - Fax:815-788-1422
Practice Address - Street 1:4701 N OAK ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3309
Practice Address - Country:US
Practice Address - Phone:815-788-1020
Practice Address - Fax:815-788-1422
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0098392251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics