Provider Demographics
NPI:1619083664
Name:FITZGERALD, SEAN M (MPT)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:74 VT ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-3011
Mailing Address - Country:US
Mailing Address - Phone:802-899-5200
Mailing Address - Fax:802-899-5800
Practice Address - Street 1:74 VT ROUTE 15
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-3011
Practice Address - Country:US
Practice Address - Phone:802-899-5200
Practice Address - Fax:802-899-5800
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist