Provider Demographics
NPI:1801421698
Name:FISHEL, SARA JO (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JO
Last Name:FISHEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13355 N HWY 183 APT 1827
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-7145
Mailing Address - Country:US
Mailing Address - Phone:210-685-0540
Mailing Address - Fax:
Practice Address - Street 1:13740 RESEARCH BLVD STE V4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1841
Practice Address - Country:US
Practice Address - Phone:512-730-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1314784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist