Provider Demographics
NPI:1558518993
Name:FITZGIBBONS, JAMIE LYN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYN
Last Name:FITZGIBBONS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:LYN
Other - Last Name:STRUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:58 SCHOOL HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3455
Mailing Address - Country:US
Mailing Address - Phone:203-679-6750
Mailing Address - Fax:
Practice Address - Street 1:22 MASONIC AVE
Practice Address - Street 2:MASONIC HEALTHCARE CENTER
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3048
Practice Address - Country:US
Practice Address - Phone:203-679-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0067372251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics