MEDICARE: MS. SUZANNE W FISHER PHYSICAL THERAPIST

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	015266-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992973713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE W FISHER PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	PO BOX 200
Second Line	:	CSE OFFICE
City	:	LAKE LUZERNE
State	:	NY
Zip	:	12846-0200
Country	:	US
Telephone Number	:	518-696-2112
Fax Number	:	518-696-5402

Provider Business Practice Location Address
First Line	:	273 LAKE AVE.
Second Line	:	HADLEY-LUZERNE ELEMENTARY SCHOOL
City	:	LAKE LUZERNE
State	:	NY
Zip	:	12846-0200
Country	:	US
Telephone Number	:	518-696-2112
Fax Number	:

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	10/13/2011

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