Provider Demographics
NPI:1790409258
Name:FITZGERALD, MICHELLE ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANNE
Other - Last Name:DURETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-0416
Mailing Address - Country:US
Mailing Address - Phone:603-553-1964
Mailing Address - Fax:
Practice Address - Street 1:7 CAMELOT RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1633
Practice Address - Country:US
Practice Address - Phone:603-553-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist