Provider Demographics
NPI:1578966339
Name:FISH, AMY (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3546
Mailing Address - Country:US
Mailing Address - Phone:816-699-6704
Mailing Address - Fax:
Practice Address - Street 1:400 PALMETTO HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1760
Practice Address - Country:US
Practice Address - Phone:803-907-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140687225100000X
MA19604225100000X
SC6860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist