Healthcare Provider Details

I. General information

NPI: 1053134726
Provider Name (Legal Business Name): JACQUELYN FISCHER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S FAIR OAKS AVE
PASADENA CA
91105-2625
US

IV. Provider business mailing address

13163 FOUNTAIN PARK DR APT B301
PLAYA VISTA CA
90094-2421
US

V. Phone/Fax

Practice location:
  • Phone: 626-389-9300
  • Fax:
Mailing address:
  • Phone: 916-220-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: