Provider Demographics
NPI:1568614766
Name:FISHENFELD, HYMIE NONE (PT)
Entity Type:Individual
Prefix:MR
First Name:HYMIE
Middle Name:NONE
Last Name:FISHENFELD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 EVENING LIGHT LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-8033
Mailing Address - Country:US
Mailing Address - Phone:949-349-9499
Mailing Address - Fax:949-349-9498
Practice Address - Street 1:41 EVENING LIGHT LANE
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-8033
Practice Address - Country:US
Practice Address - Phone:949-349-9499
Practice Address - Fax:949-349-9498
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist