Healthcare Provider Details

I. General information

NPI: 1255392965
Provider Name (Legal Business Name): JAMES FISHER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 STATE ROUTE 12 HINGE CENTER
BARNEVELD NY
13304-2122
US

IV. Provider business mailing address

8112 STATE ROUTE 12 HINGE CENTER
BARNEVELD NY
13304-2122
US

V. Phone/Fax

Practice location:
  • Phone: 315-896-4330
  • Fax: 315-896-4331
Mailing address:
  • Phone: 315-896-4330
  • Fax: 315-896-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number027568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: