Provider Demographics
NPI:1235408386
Name:FITZPATRICK, JENNIFER (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FITZPATRICK
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 1:227 NORTHLAND CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6226
Mailing Address - Country:US
Mailing Address - Phone:319-377-0937
Mailing Address - Fax:319-377-0948
Practice Address - Street 1:227 NORTHLAND CT NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6226
Practice Address - Country:US
Practice Address - Phone:319-377-0937
Practice Address - Fax:319-377-0948
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00223721Medicaid