Provider Demographics
NPI:1598000242
Name:FISHER, AMBER RENEE (ATC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 LAUREL GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6353
Mailing Address - Country:US
Mailing Address - Phone:302-228-2584
Mailing Address - Fax:
Practice Address - Street 1:4136 LAUREL GREEN CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6353
Practice Address - Country:US
Practice Address - Phone:302-228-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260016142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer