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NPI Code Detail

MEDICARE: AUSTIN FITZPATRICK ATC

MEDICARE: AUSTIN FITZPATRICK ATC
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1851850838
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUSTIN FITZPATRICK ATC
Provider Business Mailing Address
First Line : 812 28TH ST S
Second Line :
City : LA CROSSE
State : WI
Zip : 54601-5156
Country : US
Telephone Number : 608-304-4024
Fax Number :
Provider Business Practice Location Address
First Line : 3409 N DOWNER AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-2934
Country : US
Telephone Number : 608-304-4024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2019
Last Update Date : 08/09/2023

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