Provider Demographics
NPI:1851729479
Name:FIDDES, MARTHA (PT GCS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:FIDDES
Suffix:
Gender:F
Credentials:PT GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WIGGINS PKWY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1400
Mailing Address - Country:US
Mailing Address - Phone:214-532-6810
Mailing Address - Fax:866-529-3789
Practice Address - Street 1:900 WIGGINS PKWY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1400
Practice Address - Country:US
Practice Address - Phone:214-532-6810
Practice Address - Fax:866-529-3789
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10502272251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics