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General NPI Number Information
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NPI Number | 1841096708
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Entity Type | Individual
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Provider Name | JEREMY FISHER PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 115 NJ 73 SUITE 80
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City | WEST BERLIN
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State | NJ
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Zip | 08091
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Country | US
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Telephone | 856-335-4938
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 HADDONFIELD RD APT 11306
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City | PENNSAUKEN
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State | NJ
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Zip | 08110-1251
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Country | US
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Telephone | 609-534-3321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02317500
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License Number State | NJ
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