Provider Demographics
NPI:1851961114
Name:FECHTER, NICOLE CATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CATHERINE
Last Name:FECHTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:CATHERINE
Other - Last Name:REIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:WI
Mailing Address - Zip Code:53093-0123
Mailing Address - Country:US
Mailing Address - Phone:920-838-2521
Mailing Address - Fax:
Practice Address - Street 1:825 WALTON DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-5022
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15489-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist