Provider Demographics
NPI:1417127853
Name:FITZPATRICK, KELLIE ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ANNE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ALEXANDRA RD
Mailing Address - Street 2:
Mailing Address - City:LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:07850-1748
Mailing Address - Country:US
Mailing Address - Phone:197-360-1157
Mailing Address - Fax:
Practice Address - Street 1:9 ALEXANDRA RD
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1748
Practice Address - Country:US
Practice Address - Phone:197-360-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00244400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant