Provider Demographics
NPI:1104228147
Name:FISHER, JENNIFER (MT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 W 26TH AVE
Mailing Address - Street 2:BLDG A-300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5314
Mailing Address - Country:US
Mailing Address - Phone:303-831-9393
Mailing Address - Fax:303-831-6335
Practice Address - Street 1:2490 W 26TH AVE
Practice Address - Street 2:BLDG A-300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5314
Practice Address - Country:US
Practice Address - Phone:303-831-9393
Practice Address - Fax:303-831-6335
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist