Provider Demographics
NPI:1699566463
Name:FIDELIS PHYSICAL THERAPY
Entity type:Organization
Organization Name:FIDELIS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STRUDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:910-787-0514
Mailing Address - Street 1:316 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2106
Mailing Address - Country:US
Mailing Address - Phone:910-787-0514
Mailing Address - Fax:
Practice Address - Street 1:316 S 13TH ST
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2106
Practice Address - Country:US
Practice Address - Phone:910-787-0514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy