MEDICARE: MRS. CAROLE LEIGH FISCHER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	15203	MD
2	225100000X	Physical Therapist	2305001906	VA

General Provider Information

NPI Number	:	1124289194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLE LEIGH FISCHER PT

Provider Business Mailing Address
First Line	:	2905 EXCELSIOR SPRINGS CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7614
Country	:	US
Telephone Number	:	410-215-3795
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 EXCELSIOR SPRINGS CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7614
Country	:	US
Telephone Number	:	410-215-3795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2008
Last Update Date	:	06/22/2008

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