| Doctor Name: | SAMUEL FEDO |
| NPI Number: | 1639131279 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ATC |
| License Number: | 1739 |
| Business Practice Address: | 501 E Nicollet Blvd Suite 100 Burnsville, MN - 553376732 |
| Business Phone Number: | 9524604900 |
| Business Fax Number: | 9524604901 |
| Mailing Address: | 501 E Nicollet Blvd, Suite 100 BURNSVILLE |
| State: | MN |
| Postal Code: | 553376732 |
| Phone Number: | 9524604900 |
| Fax Number: | 9524604901 |
| NPI Enumeration Date: | 04/06/2006 |
| NPI Last Update Date: | 02/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | 1739 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |