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Individual

FEDGERIA EIDENS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
320 PARK AVE APT 5, DAVIDSON, NC 28036-5552
(704) 636-5812
Mailing address
320 PARK AVE APT 5, DAVIDSON, NC 28036-5552

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
583
NC
261QP2000X
Physical Therapy Clinic/Center
583
NC

Other

Enumeration date
10/07/2014
Last updated
10/07/2014
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