Provider Demographics
NPI:1649487109
Name:FISCHER, JODI LEIGH (PT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LEIGH
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:PILARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:43475 DALCOMA DR STE 140
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3593
Practice Address - Country:US
Practice Address - Phone:586-488-2440
Practice Address - Fax:586-488-2441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI705030225100000X
MI5501008412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist