Individual
IAN MATTHEW FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
508 CONCORD PLACE RD, IRMO, SC 29063-7826
(803) 781-5785
Mailing address
508 CONCORD PLACE RD, IRMO, SC 29063-7826
(803) 781-5785
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
03/25/2007
Last updated
07/08/2007
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