Provider Demographics
NPI:1346505138
Name:FITZGERALD, DANIEL JASON (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JASON
Last Name:FITZGERALD
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Gender:M
Credentials:MS, LAT, ATC
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Mailing Address - Street 1:190 ROSEWOOD CENTRE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7628
Mailing Address - Country:US
Mailing Address - Phone:919-238-2000
Mailing Address - Fax:919-238-5010
Practice Address - Street 1:190 ROSEWOOD CENTRE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7628
Practice Address - Country:US
Practice Address - Phone:919-238-2000
Practice Address - Fax:919-238-5010
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC17002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer