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General NPI Number Information
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NPI Number | 1609501352
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Entity Type | Individual
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Provider Name | THOMAS FITZGERALD PT
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Gender | Male
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 29353 CANWOOD ST
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City | AGOURA HILLS
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State | CA
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Zip | 91301-1594
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Country | US
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Telephone | 747-225-8042
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1806
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City | DURHAM
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State | NC
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Zip | 27702-1806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 295630
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License Number State | CA
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