Provider Demographics
NPI:1356596209
Name:FISHER, PETER ROSS (BAPPSCI(PT), MA)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:ROSS
Last Name:FISHER
Suffix:
Gender:M
Credentials:BAPPSCI(PT), MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37 NAGLE AVE
Mailing Address - Street 2:APT. 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1422
Mailing Address - Country:US
Mailing Address - Phone:646-239-0269
Mailing Address - Fax:
Practice Address - Street 1:37 NAGLE AVE
Practice Address - Street 2:APT. 6E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1422
Practice Address - Country:US
Practice Address - Phone:646-239-0269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022571-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics