Provider Demographics
NPI:1679563308
Name:FITZGERALD, JAYNE LEE (PT)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:LEE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:LEE
Other - Last Name:HELLKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1110 VINYARD RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-3632
Mailing Address - Country:US
Mailing Address - Phone:540-343-0466
Mailing Address - Fax:540-345-2261
Practice Address - Street 1:1110 VINYARD RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-3632
Practice Address - Country:US
Practice Address - Phone:540-343-0466
Practice Address - Fax:540-345-2261
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist