Provider Demographics
NPI:1699740605
Name:FISCHER, BRAD D (MSPT)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:D
Last Name:FISCHER
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 1:244 S CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-2322
Mailing Address - Country:US
Mailing Address - Phone:605-745-4761
Mailing Address - Fax:605-745-4762
Practice Address - Street 1:244 S CHICAGO ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-2322
Practice Address - Country:US
Practice Address - Phone:406-748-3600
Practice Address - Fax:406-748-3606
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1962225100000X
SD1492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401905Medicaid
MT000061381OtherBLUE SHIELD PROVIDER NUMB
MT3401905Medicaid