Provider Demographics
NPI:1316044902
Name:FITZHUGH, JERI ELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JERI
Middle Name:ELLEN
Last Name:FITZHUGH
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 1:312 E VENICE AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4677
Mailing Address - Country:US
Mailing Address - Phone:941-485-7725
Mailing Address - Fax:947-485-7725
Practice Address - Street 1:312 E VENICE AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4677
Practice Address - Country:US
Practice Address - Phone:941-485-7725
Practice Address - Fax:947-485-7725
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9095Medicare ID - Type Unspecified