MEDICARE: MR. HAROLD F FISK 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	15098	CA

General Provider Information

NPI Number	:	1801936810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAROLD F FISK PT

Provider Business Mailing Address
First Line	:	2001 MCALLISTER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-4436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 VAN NESS AVE
Second Line	:	#250
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-3244
Country	:	US
Telephone Number	:	415-346-4008
Fax Number	:	415-346-2029

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/09/2007

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