Provider Demographics
NPI:1447241401
Name:FECHNER, TIMOTHY DUANE (DPT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DUANE
Last Name:FECHNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2329
Mailing Address - Country:US
Mailing Address - Phone:563-382-1289
Mailing Address - Fax:563-382-4824
Practice Address - Street 1:811 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2329
Practice Address - Country:US
Practice Address - Phone:563-382-1289
Practice Address - Fax:563-382-4824
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39646OtherBLUE CROSS
IA39646OtherBLUE CROSS