Healthcare Provider Details

I. General information

NPI: 1578929865
Provider Name (Legal Business Name): BRIANNA FITZPATRICK PT, DPT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2016
Last Update Date: 01/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S COLLEGE AVE SUITE 160
NEWARK DE
19713-1302
US

IV. Provider business mailing address

540 S COLLEGE AVE SUITE 160
NEWARK DE
19713-1302
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-8893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003385
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25609
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: