Basic Information
| Provider Information | |||||||||
| NPI: | 1568117265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZGERALD | ||||||||
| FirstName: | DAWN | ||||||||
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| Credential: | PT, DPT, NCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11811 E EMPIRE AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992064533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092174363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1110 E WESTVIEW CT | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992181326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093810045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2022 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 61153063 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.