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General NPI Number Information
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NPI Number | 1952542458
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Entity Type | Individual
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Provider Name | THAMARA DAYMIEL FITZGERALD P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 444 N WELLS ST STE 304
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City | CHICAGO
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State | IL
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Zip | 60654-4593
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Country | US
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Telephone | 312-494-9936
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Fax |
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Provider Business Mailing Address
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Address Line | 1531 N 23RD AVE
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City | MELROSE PARK
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State | IL
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Zip | 60160-1805
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Country | US
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Telephone | 708-681-6334
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 070009886
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License Number State | IL
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