Provider Demographics
NPI:1790719847
Name:FITZGERALD, LINDA M (RPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:MIDNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:23595 MOULTON PKWY
Mailing Address - Street 2:STE E
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1939
Mailing Address - Country:US
Mailing Address - Phone:714-823-4400
Mailing Address - Fax:714-823-4404
Practice Address - Street 1:23595 MOULTON PKWY STE E
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1939
Practice Address - Country:US
Practice Address - Phone:949-218-0853
Practice Address - Fax:949-218-0856
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT19144BMedicare PIN
CAP70621Medicare UPIN