MEDICARE: THOMAS FITZGERALD PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	295630	CA

General Provider Information

NPI Number	:	1609501352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS FITZGERALD PT

Provider Business Mailing Address
First Line	:	PO BOX 1806
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27702-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29353 CANWOOD ST
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1594
Country	:	US
Telephone Number	:	747-225-8042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	07/18/2022

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