Provider Demographics
NPI:1477759488
Name:FITZGERALD, GERALDINE (CMT)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 MARLOW RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2421
Mailing Address - Country:US
Mailing Address - Phone:707-548-4997
Mailing Address - Fax:707-575-7639
Practice Address - Street 1:2200 RANGE AVE
Practice Address - Street 2:100
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-9471
Practice Address - Country:US
Practice Address - Phone:707-548-4997
Practice Address - Fax:707-575-7639
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist