Provider Demographics
NPI:1518968973
Name:BROVENDER-FISHER, LAURA (PT,CHT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BROVENDER-FISHER
Suffix:
Gender:F
Credentials:PT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6427
Mailing Address - Country:US
Mailing Address - Phone:215-947-2673
Mailing Address - Fax:215-947-2673
Practice Address - Street 1:500 WELSH RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6427
Practice Address - Country:US
Practice Address - Phone:215-947-2673
Practice Address - Fax:215-947-2673
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-006912L2251H1200X
PAPT006912L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11469931OtherCAQH
PA11469931OtherCAQH