Healthcare Provider Details

I. General information

NPI: 1134850720
Provider Name (Legal Business Name): AIDAN FITZPATRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 EAST MAIN ST
WATERBURY CT
06705-2608
US

IV. Provider business mailing address

22 TOMPKINS STREET
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 203-575-0516
  • Fax: 203-575-0682
Mailing address:
  • Phone: 203-419-0381
  • Fax: 203-419-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14.013486-TEMP
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: