Provider Demographics
NPI:1215211057
Name:FISHER, BETH E (PT)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:E
Last Name:FISHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 ALCAZAR ST
Mailing Address - Street 2:CHP 155
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-9006
Mailing Address - Country:US
Mailing Address - Phone:323-442-2796
Mailing Address - Fax:323-442-1515
Practice Address - Street 1:1540 ALCAZAR ST
Practice Address - Street 2:CHP 155
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-9006
Practice Address - Country:US
Practice Address - Phone:323-442-2796
Practice Address - Fax:323-442-1515
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist