Individual
TARA FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3680 N WICKHAM RD STE B, MELBOURNE, FL 32935-2327
(321) 255-5500
(321) 255-5551
Mailing address
5565 N WICKHAM RD, MELBOURNE, FL 32940-7304
(407) 573-3352
(407) 573-3355
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2782
HI
225100000X
Physical Therapist
28732
FL
225100000X
Physical Therapist
9639
CO
2251X0800X
Orthopedic Physical Therapist
Primary
PT28732
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28732
FL LICENSE
FL
01
—
9639
CO LICENSE
CO
Enumeration date
07/06/2007
Last updated
10/03/2024
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