Provider Demographics
NPI:1003224031
Name:FITZPATRICK, NICOLE P (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:P
Last Name:FITZPATRICK
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 1:53 NOTCHWAY DR
Mailing Address - Street 2:
Mailing Address - City:FRANCONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03580-4401
Mailing Address - Country:US
Mailing Address - Phone:262-442-4475
Mailing Address - Fax:
Practice Address - Street 1:53 NOTCHWAY DR
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-4401
Practice Address - Country:US
Practice Address - Phone:262-442-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAAA388505OtherHARVARD PILGRIM HEALTHCARE
NH08Y025488NH01OtherANTHEM
NH08Y025488NH01OtherANTHEM