Provider Demographics
NPI:1275551962
Name:FISHMAN, CHERYL A (MSPT)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 CROMWELL BRIDGE ROAD
Mailing Address - Street 2:CARE RESOURCES
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-583-1515
Mailing Address - Fax:410-583-2491
Practice Address - Street 1:1026 CROMWELL BRIDGE ROAD
Practice Address - Street 2:CARE RESOURCES
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-583-1515
Practice Address - Fax:410-583-2491
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10386225100000X
MD22135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7040761OtherAETNA
NC079WKOtherBCBS
NC7212031Medicaid
NC694564/Z965FNOtherACN/MPN/UHC
2508256Medicare ID - Type Unspecified