MEDICARE: CAROLINE FITZPATRICK PT, DPT

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	12954	CT
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1962006437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE FITZPATRICK PT, DPT

Provider Business Mailing Address
First Line	:	1377 MOTOR PKWY STE 307
Second Line	:
City	:	ISLANDIA
State	:	NY
Zip	:	11749-5258
Country	:	US
Telephone Number	:	631-580-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 HILL BLVD STE P
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1209
Country	:	US
Telephone Number	:	631-580-5200
Fax Number	:

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

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	12/04/2020

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