Provider Demographics
NPI:1235655523
Name:FISCHER, K. GARRETT (DPT)
Entity Type:Individual
Prefix:
First Name:K. GARRETT
Middle Name:
Last Name:FISCHER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 WHISKEY JACK RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8810
Mailing Address - Country:US
Mailing Address - Phone:815-980-0269
Mailing Address - Fax:
Practice Address - Street 1:30336 HIGHWAY 200 STE B
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9775
Practice Address - Country:US
Practice Address - Phone:208-265-8333
Practice Address - Fax:208-263-1394
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT5348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist