Provider Demographics
NPI:1154344208
Name:FISHER, JOHN J (MSPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:FISHER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG 4, SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-4128
Practice Address - Fax:609-896-0962
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00761900225100000X
PAPT011973L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053712Medicare PIN
NJ063030Medicare PIN