Provider Demographics
NPI:1215491675
Name:FISCELLA, JOSEPH M (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:FISCELLA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 INVERNESS ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-4720
Mailing Address - Country:US
Mailing Address - Phone:239-333-5206
Mailing Address - Fax:
Practice Address - Street 1:1504 INVERNESS ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-4720
Practice Address - Country:US
Practice Address - Phone:239-333-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy