Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1931-024 | WI |
NPI | 1073699633 |
---|---|
Provider Name | Joanne Fitzgerald |
First Address | Milwaukee, WI 53235-5229 |
Second Address | Wauwatosa, WI 53226-3533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41806800 | (05) | WI |