Provider Demographics
NPI:1457419442
Name:FISHER, ERIC THOMAS (RPT, MPT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:THOMAS
Last Name:FISHER
Suffix:
Gender:M
Credentials:RPT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 S LAKESHORE BLVD
Mailing Address - Street 2:#33
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1242
Mailing Address - Country:US
Mailing Address - Phone:512-589-1372
Mailing Address - Fax:512-916-4714
Practice Address - Street 1:1818 S LAKESHORE BLVD
Practice Address - Street 2:#33
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-1242
Practice Address - Country:US
Practice Address - Phone:512-589-1372
Practice Address - Fax:512-916-4714
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154500225100000X
NY028792-1225100000X
LA04027R225100000X
FLPT14777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist