Provider Demographics
NPI:1952593550
Name:FISHER, LAURIE ANN (DPT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:FISHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:95 MATHEWS DR
Mailing Address - Street 2:SUITE D5
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3734
Mailing Address - Country:US
Mailing Address - Phone:843-681-5640
Mailing Address - Fax:843-681-5631
Practice Address - Street 1:95 MATHEWS DR
Practice Address - Street 2:SUITE D5
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-3734
Practice Address - Country:US
Practice Address - Phone:843-681-5640
Practice Address - Fax:843-681-5631
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009919225100000X
SC55502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8783Medicare PIN