Individual
MISTI D FIDDELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
321 GRAND AVE, RAVENNA, NE 68869-1321
(308) 452-7154
(308) 452-3394
Mailing address
321 GRAND AVE, RAVENNA, NE 68869-1321
(308) 452-7154
(308) 452-3394
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1761
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39601
BLUE CROSS BLUE SHIELD
NE
05
—
470769316
—
NE
01
—
650024438
RAILROAD MEDICARE
NE
Enumeration date
05/24/2006
Last updated
10/24/2022
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