Doctor Name: | MRS. JAIME FITZGERALD |
NPI Number: | 1205035946 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 023210 |
Business Practice Address: | 1471 Ivy Rd Mohegan Lake, NY - 105471425 |
Business Phone Number: | 9146033841 |
Business Fax Number: | 9146033841 |
Mailing Address: | 1471 Ivy Rd, MOHEGAN LAKE |
State: | NY |
Postal Code: | 105471425 |
Phone Number: | 9146033841 |
Fax Number: | 9146033841 |
NPI Enumeration Date: | 07/12/2007 |
NPI Last Update Date: | 07/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | 023210 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |