Provider Demographics
NPI:1841096708
Name:FISHER, JEREMY (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:FISHER
Suffix:
Gender:
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 1:2100 HADDONFIELD RD APT 11306
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1251
Mailing Address - Country:US
Mailing Address - Phone:609-534-3321
Mailing Address - Fax:
Practice Address - Street 1:115 NJ 73
Practice Address - Street 2:SUITE 80
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091
Practice Address - Country:US
Practice Address - Phone:856-335-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02317500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist