Provider Demographics
NPI:1376552968
Name:FITZGERALD, PAUL E (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 W KELLOGG RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8009
Mailing Address - Country:US
Mailing Address - Phone:360-746-6679
Mailing Address - Fax:360-746-6014
Practice Address - Street 1:143 W KELLOGG RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-746-6679
Practice Address - Fax:360-746-6014
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8859748Medicare UPIN