Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 010153-1 | NY |
NPI | 1346259207 |
---|---|
Provider Name | Mr. Michael G. Fisher |
First Address | Sayville, NY 11782-3226 |
Second Address | Sayville, NY 11782-3226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |