Provider Demographics
NPI:1770236796
Name:FITZPATRICK, AUSTIN (LMT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7356 OHIO 729 NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160
Mailing Address - Country:US
Mailing Address - Phone:740-606-8069
Mailing Address - Fax:
Practice Address - Street 1:7356 OHIO 729 NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160
Practice Address - Country:US
Practice Address - Phone:740-606-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025716225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty