MEDICARE: MR. RON D. FISCHER PT/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	225100000X	Physical Therapist	4505	MN

General Provider Information

NPI Number	:	1902873847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RON D. FISCHER PT/ATC

Provider Business Mailing Address
First Line	:	21440 S LAKE GEORGE DR NW
Second Line	:
City	:	CEDAR
State	:	MN
Zip	:	55011-9225
Country	:	US
Telephone Number	:	612-799-4137
Fax Number	:

Provider Business Practice Location Address
First Line	:	23168 SAINT FRANCIS BLVD NW
Second Line	:	SUITE 300 ST. FRANCIS NOVACARE REHABILIATION
City	:	ST FRANCIS
State	:	MN
Zip	:	55070-9805
Country	:	US
Telephone Number	:	763-753-9301
Fax Number	:	763-753-9305

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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