Provider Demographics
NPI:1558484303
Name:FISHER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FISHER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY-MANION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-642-8599
Mailing Address - Street 1:1321 COLLEGE ST STE D
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-4706
Mailing Address - Country:US
Mailing Address - Phone:530-662-0378
Mailing Address - Fax:530-662-9093
Practice Address - Street 1:1321 COLLEGE ST STE D
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-4706
Practice Address - Country:US
Practice Address - Phone:530-662-0378
Practice Address - Fax:530-662-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT228610Medicare ID - Type Unspecified