Provider Demographics
NPI:1881909497
Name:FITZGERALD, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
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 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-2000
Mailing Address - Fax:631-824-9219
Practice Address - Street 1:1 TOWNE CTR
Practice Address - Street 2:SUITE 1007
Practice Address - City:CLIFFSIDE PK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2056
Practice Address - Country:US
Practice Address - Phone:201-840-4063
Practice Address - Fax:201-840-4064
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist