MEDICARE: MRS. ALYSSA FISCHER LAT, ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1760181143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYSSA FISCHER LAT, ATC

Provider Business Mailing Address
First Line	:	172 E MAIN ST
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9700
Country	:	US
Telephone Number	:	610-804-1215
Fax Number	:

Provider Business Practice Location Address
First Line	:	4897 N TWIN VALLEY RD
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9340
Country	:	US
Telephone Number	:	610-286-8600
Fax Number	:

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

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	02/24/2023

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