MEDICARE: MRS. MANDY ANTOINETTE FISHER

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	2305204274	VA

General Provider Information

NPI Number	:	1942501259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MANDY ANTOINETTE FISHER

Provider Business Mailing Address
First Line	:	1545 LONE OAK RD
Second Line	:
City	:	CHASE CITY
State	:	VA
Zip	:	23924-5017
Country	:	US
Telephone Number	:	724-984-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 LONE OAK RD
Second Line	:
City	:	CHASE CITY
State	:	VA
Zip	:	23924-5017
Country	:	US
Telephone Number	:	724-984-8664
Fax Number	:

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

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	12/20/2024

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