Provider Demographics
NPI:1053420737
Name:FITZGERALD, DONALD HENRY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:HENRY
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2218 GEORGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OPELAUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6901
Mailing Address - Country:US
Mailing Address - Phone:337-942-1933
Mailing Address - Fax:337-942-6305
Practice Address - Street 1:2218 GEORGE DRIVE
Practice Address - Street 2:
Practice Address - City:OPELAUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6901
Practice Address - Country:US
Practice Address - Phone:337-942-1933
Practice Address - Fax:337-942-6305
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56039Medicare ID - Type Unspecified