Individual provider Active NPI

Monica J Fiedler, P.T.

  • Pediatric Physical Therapist
  • Crystal Lake, IL
National Provider Identifier
1265443923
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
070-009839 Issued in IL
Practice address
4701 N Oak St
Crystal Lake, IL 60012-3309
Phone
(815) 788-1020
Fax
(815) 788-1422
NPI assigned
Aug 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 070-009839 IL Primary

Addresses

Primary practice location

4701 N Oak St
Crystal Lake, IL 60012-3309

Mailing address

4701 N Oak St
Crystal Lake, IL 60012-3309
Phone (815) 788-1020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-009839ILMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Center for Childrens Development NFP Pediatrics Past Accepting new patients
TLC Centers for Therapy PastSince Feb 1, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1265443923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 N OAK ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123309",
            "telephone_number": "815-788-1020",
            "fax_number": "815-788-1422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 N OAK ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123309",
            "telephone_number": "815-788-1020",
            "fax_number": "815-788-1422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIEDLER",
        "first_name": "MONICA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "IL",
            "license": "070-009839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.