Provider Demographics
NPI:1477711588
Name:FISH, BARBARA M (LMT)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:M
Last Name:FISH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:M
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2720 NW 6TH ST.
Mailing Address - Street 2:STE. 205
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2998
Mailing Address - Country:US
Mailing Address - Phone:352-373-4626
Mailing Address - Fax:
Practice Address - Street 1:2720 NW 6TH ST
Practice Address - Street 2:STE. 205
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2994
Practice Address - Country:US
Practice Address - Phone:352-373-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA10081225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5264OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLMA10081OtherSTATE OF FLORIDA MASSAGE LICENSE