Justin M Fedie, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10260024 Issued in WI

Practice address

555 E Townline Rd Ste 24
Vernon Hills, IL 60061-1552

Phone

(847) 573-0051

Fax

(847) 573-0345

NPI assigned

Jul 3, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Sports Physical Therapy & Rehab Specialists, S.C.

  dba Athletico Physical Therapy

  • Physical Therapist
  • Kenosha, WI
  • NPI 1326150624
  NPD (past)
• Sports Physical Therapy & Rehabilitation Specialists S.C.

  dba Athletico Physical Therapy

  • Clinic/Center
  • Mukwonago, WI
  • NPI 1174187975

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1699705962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-575-6250",
            "fax_number": "630-575-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E TOWNLINE RD STE 24",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611552",
            "telephone_number": "847-573-0051",
            "fax_number": "847-573-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDIE",
        "first_name": "JUSTIN",
        "middle_name": "M",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10260024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40442300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0604410001",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Parinita Ezhilarasan, PA-C
• Robert Joseph Fabsik Jr., D.O.
• Julia Fakhoury, MSW, LSW
• Vincent E. Fang, MD
• Chritine Farrell
• Jenna Feigen, R.N.
• Frances Qing Feng, MS,RD,LDN
• Sylvestr Ferents, SA
• Christina M Ferguson, DPT
• Veronica Tumangan Fernandez, FNP-C

• Physical Therapist in Vernon Hills, IL
• Providers in Vernon Hills, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.