Provider Demographics
NPI:1487874467
Name:FEDER, ERIC PHILIP (LPT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:PHILIP
Last Name:FEDER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1135 FOREST HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-4082
Mailing Address - Country:US
Mailing Address - Phone:618-257-5770
Mailing Address - Fax:618-257-6929
Practice Address - Street 1:4500 MEMORIAL DRIVE
Practice Address - Street 2:MEMORIAL HOSPITAL PHYSICAL THERAPY DEPT
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-257-5258
Practice Address - Fax:618-257-6929
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist