MEDICARE: ANDREA MARIE FISHLOCK 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	PT007363L	PA

General Provider Information

NPI Number	:	1881925253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MARIE FISHLOCK PT

Provider Business Mailing Address
First Line	:	1311 ROUTE 100
Second Line	:	LOWER LEVEL
City	:	BARTO
State	:	PA
Zip	:	19504-8724
Country	:	US
Telephone Number	:	610-845-5000
Fax Number	:	610-845-5011

Provider Business Practice Location Address
First Line	:	1311 ROUTE 100
Second Line	:	LOWER LEVEL
City	:	BARTO
State	:	PA
Zip	:	19504-8724
Country	:	US
Telephone Number	:	610-845-5000
Fax Number	:	610-845-5011

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

Provider Enumeration Date	:	01/24/2010
Last Update Date	:	12/23/2013

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Directions to “ ANDREA MARIE FISHLOCK PT” Practice Location

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