Provider Demographics
NPI:1912960915
Name:HABERL-FISHER, HOLLY M (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:HABERL-FISHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1107 NE 45TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4631
Practice Address - Country:US
Practice Address - Phone:206-545-7844
Practice Address - Fax:206-545-7843
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8332587Medicaid
WAG8871461Medicare PIN
WAG8905413Medicare PIN
WA8332587Medicaid