Provider Demographics
NPI:1386367290
Name:FITZGERALD, QUARON (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:QUARON
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:MR
Other - First Name:RON
Other - Middle Name:
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:812 N IVERSON ST APT 104
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6824
Mailing Address - Country:US
Mailing Address - Phone:804-475-0889
Mailing Address - Fax:
Practice Address - Street 1:812 N IVERSON ST APT 104
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-6824
Practice Address - Country:US
Practice Address - Phone:804-475-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260037152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer