Provider Demographics
NPI:1831284231
Name:FISCHVOGT, MICHAEL N (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:FISCHVOGT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 WEST CARSON STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-543-4655
Mailing Address - Fax:310-543-1743
Practice Address - Street 1:3878 WEST CARSON STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-543-4655
Practice Address - Fax:310-543-1743
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 12037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 12037OtherCA PHYSICAL THERAPY LIC.
CAPT 12037OtherCA PHYSICAL THERAPY LIC.