Provider Demographics
NPI:1407368111
Name:FISHER, STEPHAN RYAN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:RYAN
Last Name:FISHER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10348 ROSS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8439
Mailing Address - Country:US
Mailing Address - Phone:719-323-5332
Mailing Address - Fax:
Practice Address - Street 1:222 BARTLETT DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1608
Practice Address - Country:US
Practice Address - Phone:719-323-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000256102255A2300X
TXAT67722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer