MEDICARE: MS. KATHERINE SUE FISHER PT

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
1	225100000X	Physical Therapist	L926765	MI

General Provider Information

NPI Number	:	1356542286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE SUE FISHER PT

Provider Business Mailing Address
First Line	:	10831 GRANGE AVE
Second Line	:
City	:	SPARTA
State	:	MI
Zip	:	49345-8342
Country	:	US
Telephone Number	:	616-887-4905
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 ALGER ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3827
Country	:	US
Telephone Number	:	616-819-7050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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