Provider Demographics
NPI:1255446977
Name:FITZSIMMONS, MOLLIE ANNE (DPT)
Entity type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:ANNE
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:ANNE
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5650 EL CAMINO REAL
Mailing Address - Street 2:STE 120
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7126
Mailing Address - Country:US
Mailing Address - Phone:760-919-2688
Mailing Address - Fax:760-814-8069
Practice Address - Street 1:5650 EL CAMINO REAL
Practice Address - Street 2:STE 120
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7126
Practice Address - Country:US
Practice Address - Phone:760-919-2688
Practice Address - Fax:760-502-6552
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHF245ZMedicare PIN
CAW17215AMedicare PIN