Provider Demographics
NPI:1114191848
Name:FITZGERALD, ANDREA KAE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KAE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:KAE
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2759
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-2759
Mailing Address - Country:US
Mailing Address - Phone:920-830-5900
Mailing Address - Fax:920-830-5910
Practice Address - Street 1:482 OAK ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1204
Practice Address - Country:US
Practice Address - Phone:920-361-5832
Practice Address - Fax:920-361-5870
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1296019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant