Provider Demographics
NPI:1295783900
Name:FITZPATRICK PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:FITZPATRICK PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-622-9410
Mailing Address - Street 1:1252 BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5806
Mailing Address - Country:US
Mailing Address - Phone:530-622-9410
Mailing Address - Fax:530-622-9445
Practice Address - Street 1:1252 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5806
Practice Address - Country:US
Practice Address - Phone:530-622-9410
Practice Address - Fax:530-622-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64235ZOtherBLUE SHIELD ID #
CAZZZ32350ZMedicare ID - Type Unspecified