Provider Demographics
NPI:1831136589
Name:FISK, MINDY DAWN
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:DAWN
Last Name:FISK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 S NOLAND RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4743
Mailing Address - Country:US
Mailing Address - Phone:816-373-2845
Mailing Address - Fax:816-373-2842
Practice Address - Street 1:4460 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4743
Practice Address - Country:US
Practice Address - Phone:816-373-2845
Practice Address - Fax:816-373-2842
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant