Provider Demographics
NPI:1922019173
Name:FISHER, JOHN F (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14041 NORTHWEST BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5120
Mailing Address - Country:US
Mailing Address - Phone:361-387-5000
Mailing Address - Fax:361-387-5111
Practice Address - Street 1:14041 NORTHWEST BLVD STE 4
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5120
Practice Address - Country:US
Practice Address - Phone:361-387-5000
Practice Address - Fax:361-387-5111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10703801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3262Medicare PIN