Provider Demographics
NPI:1437817046
Name:FISHER, LUANNA (PTA)
Entity Type:Individual
Prefix:
First Name:LUANNA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:HORNBEAK
Mailing Address - State:TN
Mailing Address - Zip Code:38232-3433
Mailing Address - Country:US
Mailing Address - Phone:731-446-7447
Mailing Address - Fax:
Practice Address - Street 1:1105 S SUNSWEPT ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-4370
Practice Address - Country:US
Practice Address - Phone:731-885-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4397225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant