Provider Demographics
NPI:1841366499
Name:FITZGERALD, TRACEY LYNNE
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LYNNE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 OAKLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3107
Mailing Address - Country:US
Mailing Address - Phone:315-335-4048
Mailing Address - Fax:
Practice Address - Street 1:3400 SENECA TPKE
Practice Address - Street 2:SUITE 7
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-4632
Practice Address - Country:US
Practice Address - Phone:315-697-8514
Practice Address - Fax:315-697-8147
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027618-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist