Provider Demographics
NPI:1083669485
Name:FITZGERALD, LINEA B (MPT)
Entity Type:Individual
Prefix:
First Name:LINEA
Middle Name:B
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W PACES FERRY RD NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1398
Mailing Address - Country:US
Mailing Address - Phone:404-605-9091
Mailing Address - Fax:404-605-7178
Practice Address - Street 1:107 W PACES FERRY RD NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1398
Practice Address - Country:US
Practice Address - Phone:404-605-9091
Practice Address - Fax:404-605-7178
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4895Medicare ID - Type UnspecifiedGROUP NUMBER