Provider Demographics
NPI:1669942371
Name:FITZGERALD, COURTNEY MICHELLE (PTA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:M
Other - Last Name:TROUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:416 AFFINITY ST
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:AR
Mailing Address - Zip Code:72433-3403
Mailing Address - Country:US
Mailing Address - Phone:870-637-2134
Mailing Address - Fax:
Practice Address - Street 1:416 AFFINITY ST
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:AR
Practice Address - Zip Code:72433-3403
Practice Address - Country:US
Practice Address - Phone:870-637-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4136208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation