Provider Demographics
NPI:1619533403
Name:FITZPATRICK, AMANDA NICOLE SAUCIER (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE SAUCIER
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:SAUCIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:98 BANGOR ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1603
Mailing Address - Country:US
Mailing Address - Phone:207-521-0200
Mailing Address - Fax:
Practice Address - Street 1:98 BANGOR ST STE A
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1603
Practice Address - Country:US
Practice Address - Phone:207-521-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist