Provider Demographics
NPI:1053792556
Name:FIDALGO, FELIPE (PT, DPT)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:
Last Name:FIDALGO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 FAIRVIEW RD
Mailing Address - Street 2:STE 250
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0199
Mailing Address - Country:US
Mailing Address - Phone:704-707-4282
Mailing Address - Fax:704-795-4389
Practice Address - Street 1:236 LE PHILLIP CT NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1917
Practice Address - Country:US
Practice Address - Phone:704-707-4282
Practice Address - Fax:704-795-4389
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12596032251X0800X
NCP163882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic