Provider Demographics
NPI:1205654381
Name:FIDLER, MEREDITH GRACE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:GRACE
Last Name:FIDLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:MEREDITH
Other - Middle Name:GRACE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2026 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2834
Mailing Address - Country:US
Mailing Address - Phone:269-775-1551
Mailing Address - Fax:269-775-1552
Practice Address - Street 1:2026 PARKVIEW AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2834
Practice Address - Country:US
Practice Address - Phone:269-775-1551
Practice Address - Fax:269-775-1552
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist