Provider Demographics
NPI:1346259207
Name:FISHER, MICHAEL G (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:FISHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:89 SEJON DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3226
Mailing Address - Country:US
Mailing Address - Phone:516-848-5874
Mailing Address - Fax:631-563-3357
Practice Address - Street 1:89 SEJON DR
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-3226
Practice Address - Country:US
Practice Address - Phone:516-848-5874
Practice Address - Fax:631-563-3357
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010153-12251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics