Provider Demographics
NPI:1417204272
Name:FITZPATRICK, SHANE GARRET (ATC, NASM-CPT)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:GARRET
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:ATC, NASM-CPT
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Mailing Address - Street 1:500 W UNIVERSITY AVE
Mailing Address - Street 2:LARRY K DURHAM SPORTS MEDICINE COMPLEX
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79968-8900
Mailing Address - Country:US
Mailing Address - Phone:915-747-5225
Mailing Address - Fax:915-747-6801
Practice Address - Street 1:500 W UNIVERSITY AVE
Practice Address - Street 2:LARRY K DURHAM SPORTS MEDICINE COMPLEX
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79968-8900
Practice Address - Country:US
Practice Address - Phone:915-747-5225
Practice Address - Fax:915-747-6801
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2016-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer