MEDICARE: DR. CASEY L FITZPATRICK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	27563	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063924942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY L FITZPATRICK PT

Provider Business Mailing Address
First Line	:	501 NORTON LN
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2359
Country	:	US
Telephone Number	:	443-883-0748
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 NALLEY TER
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4434
Country	:	US
Telephone Number	:	443-764-7535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	09/30/2021

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