Provider Demographics
NPI:1063455442
Name:FISHER PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:FISHER PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-387-5000
Mailing Address - Street 1:14041 NW BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5120
Mailing Address - Country:US
Mailing Address - Phone:361-387-5000
Mailing Address - Fax:361-387-5111
Practice Address - Street 1:14041 NW BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5120
Practice Address - Country:US
Practice Address - Phone:361-387-5000
Practice Address - Fax:361-387-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W664Medicare PIN