Provider Demographics
NPI:1255392965
Name:FISHER, JAMES (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FISHER
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 1:8112 STATE ROUTE 12
Mailing Address - Street 2:HINGE CENTER
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2122
Mailing Address - Country:US
Mailing Address - Phone:315-896-4330
Mailing Address - Fax:315-896-4331
Practice Address - Street 1:8112 STATE ROUTE 12
Practice Address - Street 2:HINGE CENTER
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-2122
Practice Address - Country:US
Practice Address - Phone:315-896-4330
Practice Address - Fax:315-896-4331
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8658Medicare ID - Type UnspecifiedMEDICARE NUMBER