Provider Demographics
NPI:1174062129
Name:FITZPATRICK, JACLYN MARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:MARIE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9114
Mailing Address - Country:US
Mailing Address - Phone:201-341-0953
Mailing Address - Fax:
Practice Address - Street 1:1020 JOHNSON RD STE 1400
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6002
Practice Address - Country:US
Practice Address - Phone:720-723-5079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist