Provider Demographics
NPI:1518208909
Name:FITZGERALD, HEATHER MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:FITZGERALD
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 1:4482 BARRANCA PKWY
Mailing Address - Street 2:SUITE 195
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7701
Mailing Address - Country:US
Mailing Address - Phone:949-679-3337
Mailing Address - Fax:949-679-3336
Practice Address - Street 1:2755 BRISTOL ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5985
Practice Address - Country:US
Practice Address - Phone:714-966-2950
Practice Address - Fax:714-557-2487
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist