Provider Demographics
NPI:1871678128
Name:FISHER, AMY (LPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SHAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7654
Mailing Address - Country:US
Mailing Address - Phone:817-335-7946
Mailing Address - Fax:817-335-7947
Practice Address - Street 1:160 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7654
Practice Address - Country:US
Practice Address - Phone:817-335-7946
Practice Address - Fax:817-335-7947
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist