Provider Demographics
NPI:1417609702
Name:FETTER PHYSICAL THERAPY PLC
Entity type:Organization
Organization Name:FETTER PHYSICAL THERAPY PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-964-6393
Mailing Address - Street 1:225 BEAVER KREEK CTR UNIT C
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9134
Mailing Address - Country:US
Mailing Address - Phone:319-251-3239
Mailing Address - Fax:
Practice Address - Street 1:225 BEAVER KREEK CTR UNIT C
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9134
Practice Address - Country:US
Practice Address - Phone:319-251-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy