Provider Demographics
NPI:1215999883
Name:FITZPATRICK, LAWRENCE J (LATC, PTA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:LATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3308
Mailing Address - Country:US
Mailing Address - Phone:617-696-1868
Mailing Address - Fax:
Practice Address - Street 1:170 CENTRE ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3338
Practice Address - Country:US
Practice Address - Phone:617-898-2248
Practice Address - Fax:617-898-1716
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2004225200000X
MA722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer