Provider Demographics
NPI:1770823684
Name:FIEDLER, MARIA BANG (PT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:BANG
Last Name:FIEDLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10943 PALMETTO BLVD
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615
Mailing Address - Country:US
Mailing Address - Phone:352-278-0309
Mailing Address - Fax:
Practice Address - Street 1:702 TURKEY CRK
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615
Practice Address - Country:US
Practice Address - Phone:352-278-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist