Provider Demographics
NPI:1811140759
Name:FIEBACK, LINDA ELISABETH (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ELISABETH
Last Name:FIEBACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 BRADHURST AVE
Mailing Address - Street 2:BLYTHEDALE CHILDRENS HOSPITAL -PHYSICAL THERAPY DEPT
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1637
Mailing Address - Country:US
Mailing Address - Phone:914-592-7138
Mailing Address - Fax:914-592-0712
Practice Address - Street 1:95 BRADHURST AVE
Practice Address - Street 2:BLYTHEDALE CHILDRENS HOSPITAL -PHYSICAL THERAPY DEPT
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1637
Practice Address - Country:US
Practice Address - Phone:914-592-7138
Practice Address - Fax:914-592-0712
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006367-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics