Healthcare Provider Details

I. General information

NPI: 1821391558
Provider Name (Legal Business Name): JEREMY N FISHER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31507 OAK ORCHARD RD STE 8
MILLSBORO DE
19966-5012
US

IV. Provider business mailing address

37169 REHOBOTH AVENUE EXT
REHOBOTH BEACH DE
19971-1683
US

V. Phone/Fax

Practice location:
  • Phone: 302-648-3360
  • Fax: 302-648-3362
Mailing address:
  • Phone: 302-227-2008
  • Fax: 302-227-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000708
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: