Provider Demographics
NPI:1790715902
Name:FESS, MEREDITH ANN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ANN
Last Name:FESS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:3501 MASONS MILL RD
Practice Address - Street 2:SUITE 501
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3517
Practice Address - Country:US
Practice Address - Phone:215-659-8600
Practice Address - Fax:215-659-4498
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO-16391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102198809-0001Medicaid
PA2297301000OtherIBC
PAP00692852OtherRAILROAD MEDICARE
PA11779874OtherKEYSTONE MERCY
PA1619596OtherHIGHMARK PABS
PA30060798OtherKEYSTONE MERCY
PA30060798OtherKEYSTONE MERCY