Provider Demographics
NPI:1306389671
Name:FISHER, DANIELLE (PT, DPT, ATC, MSAT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:PT, DPT, ATC, MSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 EGLOFF CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6616
Mailing Address - Country:US
Mailing Address - Phone:916-337-3818
Mailing Address - Fax:
Practice Address - Street 1:10305 PROMENADE PKWY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-9400
Practice Address - Country:US
Practice Address - Phone:916-337-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist