Healthcare Provider Details

I. General information

NPI: 1275762338
Provider Name (Legal Business Name): JUSTIN LEE FISCHER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 54TH AVE W
LYNNWOOD WA
98036-6318
US

IV. Provider business mailing address

20200 54TH AVE W
LYNNWOOD WA
98036-6318
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-6400
  • Fax: 425-672-6518
Mailing address:
  • Phone: 425-672-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5995
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60323144
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: