Provider Demographics
NPI:1023318805
Name:FISHER, SAMUEL
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 TELEGRAPH RD
Mailing Address - Street 2:STE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3464
Mailing Address - Country:US
Mailing Address - Phone:805-642-4678
Mailing Address - Fax:805-642-2038
Practice Address - Street 1:3737 TELEGRAPH RD
Practice Address - Street 2:STE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3464
Practice Address - Country:US
Practice Address - Phone:805-642-4678
Practice Address - Fax:805-642-2038
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist