Basic Information
| Provider Information | |||||||||
| NPI: | 1154524874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZGIBBON | ||||||||
| FirstName: | JAMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954767582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154206127 | ||||||||
| FaxNumber: | 7075844814 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 MEDICAL CENTER DR STE A | ||||||||
| Address2: | |||||||||
| City: | ROHNERT PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949282900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075843433 | ||||||||
| FaxNumber: | 7075844814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 26617 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.