Provider Demographics
NPI:1053684159
Name:FISHER, MARK STEPHEN (MPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:FISHER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 EUREKA WAY STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0815
Mailing Address - Country:US
Mailing Address - Phone:530-247-1280
Mailing Address - Fax:530-247-0310
Practice Address - Street 1:1225 EUREKA WAY STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0815
Practice Address - Country:US
Practice Address - Phone:530-247-1280
Practice Address - Fax:530-247-0310
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist