MEDICARE: DR. BRENT ALBERT FISHER DPT

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	34250	CA

General Provider Information

NPI Number	:	1831375344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT ALBERT FISHER DPT

Provider Business Mailing Address
First Line	:	1301 E BIDWELL ST
Second Line	:	SUITE 201
City	:	FOLSOM
State	:	CA
Zip	:	95630-3565
Country	:	US
Telephone Number	:	916-983-5915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 E BIDWELL ST
Second Line	:	SUITE 201
City	:	FOLSOM
State	:	CA
Zip	:	95630-3565
Country	:	US
Telephone Number	:	916-983-5915
Fax Number	:

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

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/03/2022

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