Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251H1200X | Hand | PT-006912L | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT006912L | PA |
NPI | 1518968973 |
---|---|
Provider Name | Laura Brovender-Fisher |
First Address | Huntingdon Valley, PA 19006-6427 |
Second Address | Huntingdon Valley, PA 19006-6427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11469931 | CAQH (01) | PA |