Provider Demographics
NPI:1851903256
Name:FIDLER, JOHN H III (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:FIDLER
Suffix:III
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 1:47 DENLER DR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1324
Mailing Address - Country:US
Mailing Address - Phone:860-214-8649
Mailing Address - Fax:
Practice Address - Street 1:633 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1220
Practice Address - Country:US
Practice Address - Phone:203-688-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0111062251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics