Provider Demographics
NPI:1942792577
Name:FITZSIMMONS, NATHANIEL ANDREW (PT, DPT, PTA)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:ANDREW
Last Name:FITZSIMMONS
Suffix:
Gender:M
Credentials:PT, DPT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20268 N 17TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4319
Mailing Address - Country:US
Mailing Address - Phone:304-281-3897
Mailing Address - Fax:
Practice Address - Street 1:16838 E PALISADES BLVD STE B121
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3789
Practice Address - Country:US
Practice Address - Phone:480-837-2595
Practice Address - Fax:480-837-2773
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ011443225200000X
WV001995225200000X
OH09818225200000X
AZLPT-31067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant