Healthcare Provider Details

I. General information

NPI: 1790647147
Provider Name (Legal Business Name): EMILY FITZGEARLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 S NETTLETON AVE
SPRINGFIELD MO
65807-5970
US

IV. Provider business mailing address

2864 S NETTLETON AVE
SPRINGFIELD MO
65807-5970
US

V. Phone/Fax

Practice location:
  • Phone: 417-605-7100
  • Fax:
Mailing address:
  • Phone: 417-605-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2014025390
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: