Provider Demographics
NPI:1831270834
Name:FISCHER, TIA MARIE (MS, PT, CSCS)
Entity type:Individual
Prefix:MRS
First Name:TIA
Middle Name:MARIE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MS, PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 ARISTA PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4154
Mailing Address - Country:US
Mailing Address - Phone:720-777-1330
Mailing Address - Fax:720-777-9236
Practice Address - Street 1:8401 ARISTA PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-4154
Practice Address - Country:US
Practice Address - Phone:720-777-1330
Practice Address - Fax:720-777-9236
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCOPT5162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IMS67413OtherBCBS
CO807392Medicare PIN
A004OtherTRICARE