Provider Demographics
NPI:1417609702
Name:FETTER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FETTER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-964-6393
Mailing Address - Street 1:203 S IOWA ST
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9434
Mailing Address - Country:US
Mailing Address - Phone:618-964-6393
Mailing Address - Fax:
Practice Address - Street 1:2910 STONER CT
Practice Address - Street 2:#9
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8525
Practice Address - Country:US
Practice Address - Phone:319-251-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy