Healthcare Provider Details

I. General information

NPI: 1265170807
Provider Name (Legal Business Name): CYRUS FITZPATRICK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

301B CAROLINA BEACH AVE S
CAROLINA BEACH NC
28428-6212
US

V. Phone/Fax

Practice location:
  • Phone: 877-772-6505
  • Fax:
Mailing address:
  • Phone: 336-501-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT210002124
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: