Healthcare Provider Details

I. General information

NPI: 1346357043
Provider Name (Legal Business Name): WILLIAM BRYAN FISHER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 VIA REAL SUITE C
CARPINTERIA CA
93013-1265
US

IV. Provider business mailing address

4180 VIA REAL SUITE C
CARPINTERIA CA
93013-1265
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0600
  • Fax: 805-566-0637
Mailing address:
  • Phone: 805-566-0600
  • Fax: 805-566-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 20274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: