Provider Demographics
NPI:1639211519
Name:FISCHER SPORTS THERAPY
Entity Type:Organization
Organization Name:FISCHER SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:MCKENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, CSCS
Authorized Official - Phone:602-437-5055
Mailing Address - Street 1:4050 E COTTON CENTER BLVD
Mailing Address - Street 2:SUITE 60
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8861
Mailing Address - Country:US
Mailing Address - Phone:602-437-5055
Mailing Address - Fax:
Practice Address - Street 1:4050 E COTTON CENTER BLVD
Practice Address - Street 2:SUITE 60
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8861
Practice Address - Country:US
Practice Address - Phone:602-437-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty