Provider Demographics
NPI:1588248041
Name:FISCHER, KAYLA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 34TH AVE E APT 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2918
Mailing Address - Country:US
Mailing Address - Phone:320-420-6463
Mailing Address - Fax:
Practice Address - Street 1:825 34TH AVE E APT 201
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2918
Practice Address - Country:US
Practice Address - Phone:320-420-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3303207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3303Medicaid