Provider Demographics
NPI:1124316740
Name:FEDA, KARLEIGH (DPT)
Entity type:Individual
Prefix:MRS
First Name:KARLEIGH
Middle Name:
Last Name:FEDA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2754
Mailing Address - Country:US
Mailing Address - Phone:860-677-5183
Mailing Address - Fax:
Practice Address - Street 1:29 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1933
Practice Address - Country:US
Practice Address - Phone:860-561-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-17
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist