Healthcare Provider Details

I. General information

NPI: 1679608848
Provider Name (Legal Business Name): TIFFANY GAIL FISHER D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK RIDGE LN
NORTH FOND DU LAC WI
54937-1385
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-926-7800
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10472
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: