Provider Demographics
NPI:1356854319
Name:FISHER, SHEA LYNN (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-0282
Mailing Address - Country:US
Mailing Address - Phone:717-816-6315
Mailing Address - Fax:
Practice Address - Street 1:9613 LINCOLN HWY STE 107
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3748
Practice Address - Country:US
Practice Address - Phone:814-623-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
PART0075702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer