Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 27563 | MD |
NPI | 1063924942 |
---|---|
Provider Name | Dr. Casey L Fitzpatrick |
First Address | Arnold, MD 21012-2359 |
Second Address | Landover, MD 20785-4434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2017 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063924942 | (05) | NY |
158198800 | (05) | MD |