Healthcare Provider Details

I. General information

NPI: 1215211057
Provider Name (Legal Business Name): BETH E FISHER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 ALCAZAR ST CHP 155
LOS ANGELES CA
90089-9006
US

IV. Provider business mailing address

1540 ALCAZAR ST CHP 155
LOS ANGELES CA
90089-9006
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-2796
  • Fax: 323-442-1515
Mailing address:
  • Phone: 323-442-2796
  • Fax: 323-442-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: