Provider Demographics
NPI:1417525577
Name:FEICKERT, ADISON (PT, DPT)
Entity type:Individual
Prefix:
First Name:ADISON
Middle Name:
Last Name:FEICKERT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 MALLARD CREST DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-8218
Mailing Address - Country:US
Mailing Address - Phone:707-338-6567
Mailing Address - Fax:
Practice Address - Street 1:1209 MALLARD CREST DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89441-8218
Practice Address - Country:US
Practice Address - Phone:707-338-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304384225100000X
TX1347040225100000X
NV5192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist