Provider Demographics
NPI:1043647670
Name:FISHER, ROBERTA (LMP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 138 ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-8296
Mailing Address - Country:US
Mailing Address - Phone:253-326-4495
Mailing Address - Fax:
Practice Address - Street 1:7115 138TH ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-8296
Practice Address - Country:US
Practice Address - Phone:253-326-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60405072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherDEPARTMENT OF HEALTH