Provider Demographics
NPI:1902913635
Name:FISHER, MICHAEL BYRON (MPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BYRON
Last Name:FISHER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N ALLEN DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:972-727-9888
Mailing Address - Fax:972-727-9909
Practice Address - Street 1:202 N ALLEN DR
Practice Address - Street 2:SUITE C
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-727-9888
Practice Address - Fax:972-727-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1102515225100000X
TX1102515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087741701Medicaid
TX087741701Medicaid
TX650488Medicare PIN