Provider Demographics
NPI:1366167678
Name:FISHER, ROBIN W (LPTA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:W
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:LYNN
Other - Last Name:WINSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8175 HAW BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:NC
Mailing Address - Zip Code:27807-9712
Mailing Address - Country:US
Mailing Address - Phone:252-315-2754
Mailing Address - Fax:
Practice Address - Street 1:2701 CHESTNUT STATION CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6395
Practice Address - Country:US
Practice Address - Phone:800-335-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3643225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA3643OtherNC PT BOARD