Provider Demographics
NPI:1740703362
Name:FITZGERALD, KRYSTYNA UTZIG (DPT)
Entity type:Individual
Prefix:DR
First Name:KRYSTYNA
Middle Name:UTZIG
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KRYSTYNA
Other - Middle Name:SHARLENE
Other - Last Name:UTZIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 N BRACKEN FERN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-3008
Mailing Address - Country:US
Mailing Address - Phone:703-201-3276
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty