Provider Demographics
NPI:1659503340
Name:FITZGIBBON, GERALD C
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:C
Last Name:FITZGIBBON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15294
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28813-0294
Mailing Address - Country:US
Mailing Address - Phone:828-698-3489
Mailing Address - Fax:828-698-3490
Practice Address - Street 1:105 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-1200
Practice Address - Country:US
Practice Address - Phone:580-795-3301
Practice Address - Fax:580-795-7307
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist