MEDICARE: ROBERT JEREMY FISHER JR. P.T.

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	PT-0002429	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y2044	OTHER	FL	BCBS OF FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740375336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JEREMY FISHER JR. P.T.

Provider Business Mailing Address
First Line	:	PO BOX 699
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33845-0699
Country	:	US
Telephone Number	:	863-206-2854
Fax Number	:	863-422-6233

Provider Business Practice Location Address
First Line	:	8316 WEST LAKE MARION ROAD
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844
Country	:	US
Telephone Number	:	863-206-2854
Fax Number	:	863-422-6233

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/01/2015

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