Provider Demographics
NPI:1477516334
Name:FITZPATRICK, BRIAN C (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 TINGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-3354
Mailing Address - Country:US
Mailing Address - Phone:917-476-5496
Mailing Address - Fax:
Practice Address - Street 1:649 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1518
Practice Address - Country:US
Practice Address - Phone:973-315-3124
Practice Address - Fax:973-315-3184
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA009850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055402Medicare ID - Type UnspecifiedPHYSICAL THERAPY