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General NPI Number Information
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NPI Number | 1780274159
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Entity Type | Individual
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Provider Name | MADELINE MARIE FITZPATRICK LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 20 TOWER PKWY
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City | NEW HAVEN
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State | CT
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Zip | 06511-3640
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Country | US
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Telephone | 203-432-2467
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Fax |
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Provider Business Mailing Address
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Address Line | 7 BRUNSWICK RD
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City | SHELTON
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State | CT
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Zip | 06484-4381
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Country | US
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Telephone | 516-304-6459
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1435
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License Number State | CT
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