Provider Demographics
NPI:1669408647
Name:FITZPATRICK, PATRICIA MARY (PT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARY
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:MARY
Other - Last Name:MCGRAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2537
Mailing Address - Country:US
Mailing Address - Phone:732-603-0383
Mailing Address - Fax:
Practice Address - Street 1:210 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2441
Practice Address - Country:US
Practice Address - Phone:908-276-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00247700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist