Provider Demographics
NPI:1861437899
Name:FISCHER, GARY (PT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:FISCHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:200 MASON ST
Mailing Address - Street 2:STE 17
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-7061
Mailing Address - Country:US
Mailing Address - Phone:608-781-0174
Mailing Address - Fax:
Practice Address - Street 1:577 BRAUND ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8556
Practice Address - Country:US
Practice Address - Phone:608-781-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2406-012111N00000X
WI3504-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor