Provider Demographics
NPI:1639267859
Name:FISCHER, GAYLE (DPT)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8199 SOUTHPARK LN
Mailing Address - Street 2:#120
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5667
Mailing Address - Country:US
Mailing Address - Phone:303-730-7117
Mailing Address - Fax:303-730-7119
Practice Address - Street 1:8199 SOUTHPARK LN
Practice Address - Street 2:#120
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5667
Practice Address - Country:US
Practice Address - Phone:303-730-7117
Practice Address - Fax:303-730-7119
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81328354Medicaid
CO802536Medicare ID - Type Unspecified
CO81328354Medicaid