Provider Demographics
NPI:1972084655
Name:FISHER, KATRINA CLAIRE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:CLAIRE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 COFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2726
Mailing Address - Country:US
Mailing Address - Phone:303-532-0698
Mailing Address - Fax:
Practice Address - Street 1:1440 COFFMAN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2726
Practice Address - Country:US
Practice Address - Phone:303-532-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist