Provider Demographics
NPI:1073912515
Name:FITZGERALD, KATE (DPT)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:654 BEACON STREET 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:617-536-1161
Practice Address - Street 1:109 ANDREW AVE
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-4744
Practice Address - Country:US
Practice Address - Phone:617-536-1161
Practice Address - Fax:844-912-8609
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21250225100000X
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400320028Medicare PIN