Provider Demographics
NPI:1437288024
Name:FITZPATRICK, KATIE JEAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:JEAN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 MALLOY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5039
Mailing Address - Country:US
Mailing Address - Phone:925-413-0940
Mailing Address - Fax:949-673-1667
Practice Address - Street 1:3111 VILLA WAY
Practice Address - Street 2:GOLD COAST PHYSICAL THERAPY
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3823
Practice Address - Country:US
Practice Address - Phone:949-673-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFH537XMedicare PIN