Provider Demographics
NPI:1922176874
Name:FISHER, KIMBERLY B (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:FISHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 LAKE TAPPS PARKWAY E
Mailing Address - Street 2:SUITE E106
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092
Mailing Address - Country:US
Mailing Address - Phone:253-939-7179
Mailing Address - Fax:253-939-7182
Practice Address - Street 1:1408 LAKE TAPPS PARKWAY E
Practice Address - Street 2:SUITE E106
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092
Practice Address - Country:US
Practice Address - Phone:253-939-7179
Practice Address - Fax:253-939-7182
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5533755OtherAETNA
8941198OtherCRIME VICTIMS
WA176892OtherL&I
610775100OtherUS DOL
WA7757FIOtherREGENCE
WA7757FIOtherREGENCE