Provider Demographics
NPI:1821391558
Name:FISHER, JEREMY N (PTA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:N
Last Name:FISHER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37169 REHOBOTH AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-1683
Mailing Address - Country:US
Mailing Address - Phone:302-227-2008
Mailing Address - Fax:302-227-8098
Practice Address - Street 1:37169 REHOBOTH AVENUE EXT
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-1683
Practice Address - Country:US
Practice Address - Phone:302-227-2008
Practice Address - Fax:302-227-8098
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000708225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant