Provider Demographics
NPI:1124669767
Name:FISCHER, KAITLYN KRISTINE (PT,DPT, ATC)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:KRISTINE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PT,DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3080
Mailing Address - Country:US
Mailing Address - Phone:507-646-8818
Mailing Address - Fax:
Practice Address - Street 1:3708 BROADWAY AVE N STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4159
Practice Address - Country:US
Practice Address - Phone:507-322-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11493261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy