Jack Keefe Fitzgerald, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

046250 Issued in NY

Practice address

711 Troy Schenectady Rd Ste 103
Latham, NY 12110-2454

Phone

(518) 783-3110

Fax

(518) 220-9506

NPI assigned

Apr 19, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Care Physicians, PC

  • Internal Medicine Physician
  • Latham, NY
  • NPI 1023380714
  NPD (past)
• Community Care Physicians, PC

  • Physical Therapist
  • Latham, NY
  • NPI 1699047373
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1174010797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 103",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102454",
            "telephone_number": "518-783-3110",
            "fax_number": "518-220-9506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Rose Ct",
            "address_purpose": "LOCATION",
            "city": "Cohoes",
            "state": "NY",
            "postal_code": "120471524",
            "country_code": "US",
            "telephone_number": "518-210-3591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "JACK",
        "middle_name": "KEEFE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-19",
        "last_updated": "2020-09-21",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "P106547",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "046250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget M Finn, PH.D.
• Paula Fischer, OT
• Kathleen Fishman, LMHC
• Peter E. Fisk, M.D.
• Grahame W Fitz, M.D.
• Stephanie Elizabeth Fitzgerald
• Nicole Fleitz
• Joanne Marie Fogarty, MD
• Jennifer Ann Ford, NP
• Melissa Anne Ford, RPH

• Physical Therapist in Latham, NY
• Providers in Latham, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.