Provider Demographics
NPI:1811664113
Name:FEKA, LORETE (DPT, CLT, GAQ)
Entity type:Individual
Prefix:
First Name:LORETE
Middle Name:
Last Name:FEKA
Suffix:
Gender:F
Credentials:DPT, CLT, GAQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 W CHANDLER BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3356
Mailing Address - Country:US
Mailing Address - Phone:480-878-7425
Mailing Address - Fax:
Practice Address - Street 1:5690 W CHANDLER BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3356
Practice Address - Country:US
Practice Address - Phone:480-878-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist