Provider Demographics
NPI:1740239177
Name:FITZGERALD, MICHELLE PEARL (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PEARL
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 ST TROPEZ CIR
Mailing Address - Street 2:APT 1510
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3007
Mailing Address - Country:US
Mailing Address - Phone:303-918-4147
Mailing Address - Fax:
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3609
Practice Address - Country:US
Practice Address - Phone:303-918-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist