Provider Demographics
NPI:1124088281
Name:FISHER, DANIEL PAUL (PT, OCS, MHA, FACHE)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PAUL
Last Name:FISHER
Suffix:
Gender:M
Credentials:PT, OCS, MHA, FACHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-1024
Mailing Address - Fax:706-787-0182
Practice Address - Street 1:ST. JOHN TOWERS
Practice Address - Street 2:724 GREENE STREET
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-496-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist