Provider Demographics
NPI:1265281331
Name:FIDLER, BRADY (DPT)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:FIDLER
Suffix:
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 1:4740 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9672
Mailing Address - Country:US
Mailing Address - Phone:610-927-5183
Mailing Address - Fax:610-927-6994
Practice Address - Street 1:1001 JAMES DR STE A14
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8867
Practice Address - Country:US
Practice Address - Phone:484-671-2065
Practice Address - Fax:484-671-2354
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist