Provider Demographics
NPI:1275556565
Name:FISHER, SANDRA K (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
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 1:550 N 12TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1242
Mailing Address - Country:US
Mailing Address - Phone:717-737-9818
Mailing Address - Fax:717-737-2815
Practice Address - Street 1:550 N 12TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1242
Practice Address - Country:US
Practice Address - Phone:717-737-9818
Practice Address - Fax:717-737-2815
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002975L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA506259OtherBLUE SHIELD
PA506259OtherBLUE SHIELD