Provider Demographics
NPI:1336677905
Name:FATZINGER, CALEB (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:
Last Name:FATZINGER
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 LYN PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2362
Mailing Address - Country:US
Mailing Address - Phone:301-832-2217
Mailing Address - Fax:
Practice Address - Street 1:1341 HUGHES FORD RD STE 104
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3134
Practice Address - Country:US
Practice Address - Phone:301-798-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26486208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD26486OtherPT LICENSE