Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT020787 | PA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT020787 | PA |
NPI | 1063727915 |
---|---|
Provider Name | Mrs. Megan Marlene Fisher |
First Address | Blairsville, PA 15717-7032 |
Second Address | Blairsville, PA 15717-7032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2010 |
Last Update Date | 16/08/2010 |