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NPI Code Detail

MEDICARE: MR. MARK ALAN FISHER LMT

MEDICARE:  MR. MARK ALAN FISHER  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA16739FL

General Provider Information

NPI Number : 1053614073
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK ALAN FISHER LMT
Provider Business Mailing Address
First Line : 916 NE 17TH CT
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33305-3127
Country : US
Telephone Number : 954-463-6791
Fax Number : 954-463-0830
Provider Business Practice Location Address
First Line : 916 NE 17TH CT
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33305-3127
Country : US
Telephone Number : 954-463-6791
Fax Number : 954-463-0830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2010
Last Update Date : 12/13/2010

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Directions to “ MR. MARK ALAN FISHER LMT” Practice Location

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