Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE008577 | PA |
NPI | 1003258872 |
---|---|
Provider Name | Haley Marie Fisher |
First Address | Hazleton, PA 18201-3053 |
Second Address | Kennett Square, PA 19348-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 22/07/2013 |