Provider Demographics
NPI:1235669839
Name:FISHER, ROBERT MITCHELL (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MITCHELL
Last Name:FISHER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 VIENNE PL
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7634
Mailing Address - Country:US
Mailing Address - Phone:662-315-1256
Mailing Address - Fax:
Practice Address - Street 1:134 VIENNE PL
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113
Practice Address - Country:US
Practice Address - Phone:662-315-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS