Provider Demographics
NPI:1164179917
Name:FISHER, ALEXANDRIA KAITLYN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:KAITLYN
Last Name:FISHER
Suffix:
Gender:F
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 1:6479 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3802
Mailing Address - Country:US
Mailing Address - Phone:941-757-7801
Mailing Address - Fax:
Practice Address - Street 1:3300 HAMILTON MILL RD STE 109
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4083
Practice Address - Country:US
Practice Address - Phone:678-804-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38532225100000X
NY048512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT38532OtherPHYSICAL THERAPY
NY048512OtherPHYSICAL THERAPY