Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C16086 | NY |
N | 225200000X | Physical Therapy Assistant | 00256-1 | NY |
NPI | 1962570150 |
---|---|
Provider Name | Mr. Scott Alan Fisher |
First Address | Sidney, NY 13838-0292 |
Second Address | Bainbridge, NY 13733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01901037 | (05) | NY |