Provider Demographics
NPI:1013337328
Name:FITZSIMMONS, GAIL ELAINE (MPT)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ELAINE
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:FITZSIMMONS
Other - Last Name:MAZZATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:457 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7776
Mailing Address - Country:US
Mailing Address - Phone:732-840-1866
Mailing Address - Fax:732-840-1089
Practice Address - Street 1:457 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7776
Practice Address - Country:US
Practice Address - Phone:732-840-1866
Practice Address - Fax:732-840-1089
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00618900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist