Provider Demographics
NPI:1629099965
Name:PRUETT-FISHER, TERRY L (PT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:PRUETT-FISHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TYLER CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-7913
Mailing Address - Country:US
Mailing Address - Phone:717-245-2341
Mailing Address - Fax:717-245-9672
Practice Address - Street 1:1 TYLER CT
Practice Address - Street 2:SUITE 200
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-7913
Practice Address - Country:US
Practice Address - Phone:717-245-2341
Practice Address - Fax:717-245-9672
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002055E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA506259OtherBLUE SHIELD
PA506259OtherBLUE SHIELD
PA394521Medicare ID - Type UnspecifiedMEDICARE