Provider Demographics
NPI:1558754556
Name:FISH, EMMA ROSE (PT, DPT, ATC, OCS)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ROSE
Last Name:FISH
Suffix:
Gender:F
Credentials:PT, DPT, ATC, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FERNWAY DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1105
Mailing Address - Country:US
Mailing Address - Phone:330-835-7464
Mailing Address - Fax:
Practice Address - Street 1:4300 ALLEN RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1032
Practice Address - Country:US
Practice Address - Phone:330-945-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0051282255A2300X
OH017999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer