Provider Demographics
NPI:1578506481
Name:FISHER, SUSAN L (MPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 EVERGREEN KNL
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-6207
Mailing Address - Country:US
Mailing Address - Phone:810-750-1996
Mailing Address - Fax:
Practice Address - Street 1:135 S MILFORD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-2758
Practice Address - Country:US
Practice Address - Phone:248-685-7272
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP18380001Medicare ID - Type Unspecified