Provider Demographics
NPI:1710910542
Name:FISHER, SHAWNA R (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:R
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 1:6 TUCKER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2773
Mailing Address - Country:US
Mailing Address - Phone:843-681-2231
Mailing Address - Fax:
Practice Address - Street 1:6 TUCKER RIDGE CT
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2773
Practice Address - Country:US
Practice Address - Phone:843-681-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist