Provider Demographics
NPI:1992973713
Name:FISHER, SUZANNE W (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:W
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:CSE OFFICE
Mailing Address - City:LAKE LUZERNE
Mailing Address - State:NY
Mailing Address - Zip Code:12846-0200
Mailing Address - Country:US
Mailing Address - Phone:518-696-2112
Mailing Address - Fax:518-696-5402
Practice Address - Street 1:273 LAKE AVE.
Practice Address - Street 2:HADLEY-LUZERNE ELEMENTARY SCHOOL
Practice Address - City:LAKE LUZERNE
Practice Address - State:NY
Practice Address - Zip Code:12846-0200
Practice Address - Country:US
Practice Address - Phone:518-696-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015266-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00752456Medicaid