MEDICARE: MRS. LORI V FISCHER RPT

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	1105	SC

General Provider Information

NPI Number	:	1871848192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI V FISCHER RPT

Provider Business Mailing Address
First Line	:	950 CUMMINGS CIR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3506
Country	:	US
Telephone Number	:	843-452-5282
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 CUMMINGS CIR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3506
Country	:	US
Telephone Number	:	843-452-5282
Fax Number	:

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	11/27/2012

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