Provider Demographics
NPI:1154529634
Name:FISHER, TARA (DPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7304
Mailing Address - Country:US
Mailing Address - Phone:407-573-3352
Mailing Address - Fax:407-573-3355
Practice Address - Street 1:3680 N WICKHAM RD STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2327
Practice Address - Country:US
Practice Address - Phone:321-255-5500
Practice Address - Fax:321-255-5551
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2782225100000X
CO9639225100000X
FL28732225100000X
FLPT287322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9639OtherCO LICENSE
FL28732OtherFL LICENSE