Provider Demographics
NPI:1033769476
Name:FITZGERALD, HALIANN (ATC)
Entity Type:Individual
Prefix:
First Name:HALIANN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BORDENS CIR
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-3935
Mailing Address - Country:US
Mailing Address - Phone:845-522-0028
Mailing Address - Fax:
Practice Address - Street 1:1157 ROUTE 55
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540
Practice Address - Country:US
Practice Address - Phone:845-486-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20000303702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer