Provider Demographics
NPI:1548650260
Name:FEDLER, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:FEDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 225TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52656-9355
Mailing Address - Country:US
Mailing Address - Phone:319-470-9310
Mailing Address - Fax:
Practice Address - Street 1:20 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2040
Practice Address - Country:US
Practice Address - Phone:319-524-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075073225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant