Provider Demographics
NPI:1205035946
Name:FITZGERALD, JAIME (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 IVY RD
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1425
Mailing Address - Country:US
Mailing Address - Phone:914-603-3841
Mailing Address - Fax:914-603-3841
Practice Address - Street 1:1471 IVY RD
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1425
Practice Address - Country:US
Practice Address - Phone:914-603-3841
Practice Address - Fax:914-603-3841
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0232102251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics