Provider Demographics
NPI:1306885231
Name:FISH, ALINA (PT)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1321
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-0819
Mailing Address - Country:US
Mailing Address - Phone:215-266-8288
Mailing Address - Fax:215-947-4141
Practice Address - Street 1:3443 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3737
Practice Address - Country:US
Practice Address - Phone:215-266-8288
Practice Address - Fax:215-947-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-007379-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001944528Medicaid
PAS88024Medicare UPIN
PA001944528Medicaid