Provider Demographics
NPI:1861732711
Name:FISCHETTI, CHRISTOPHER DAVID (PT, ATC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:FISCHETTI
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OLIVER PL
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4440
Mailing Address - Country:US
Mailing Address - Phone:716-523-8931
Mailing Address - Fax:716-312-8525
Practice Address - Street 1:120 OLIVER PL
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4440
Practice Address - Country:US
Practice Address - Phone:716-523-8931
Practice Address - Fax:716-312-8525
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010467-1225100000X
NY0009862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist