Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 005183 | IA |
NPI | 1003241514 |
---|---|
Provider Name | Alicia J Fisher |
First Address | West Des Moines, IA 50265-1540 |
Second Address | Adel, IA 50003-2076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 04/09/2013 |