Provider Demographics
NPI:1831708809
Name:FIDELITY THERAPY SERVICES LLC
Entity type:Organization
Organization Name:FIDELITY THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZNETSOV
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:215-710-0515
Mailing Address - Street 1:83 BUSTLETON PIKE UNIT C
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6465
Mailing Address - Country:US
Mailing Address - Phone:215-710-0515
Mailing Address - Fax:215-710-0258
Practice Address - Street 1:83 BUSTLETON PIKE UNIT C
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6465
Practice Address - Country:US
Practice Address - Phone:215-710-0515
Practice Address - Fax:215-710-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)