Jesse Matthew Fitzgerald

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1533-19 Issued in WI

Practice address

228 Newhall St
Green Bay, WI 54302-1708

Phone

(715) 651-7382

NPI assigned

Nov 7, 2013

Last updated

Mar 5, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425513600000",
    "number": "1770912024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 NEWHALL ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543021708",
            "telephone_number": "715-651-7382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 NEWHALL ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543021708",
            "telephone_number": "715-651-7382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "JESSE",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-07",
        "last_updated": "2015-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "1533-19",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100033830",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kirk Richard Fishbaugh, D.D.S.
• Alyssa A Fisher, MA, LPC
• Maranda Fisher
• Suzanne Kay Fisher, LPN
• Courtney Fitzgerald Martin, MS, OTR
• Marjory Matilda Fitzgerald
• Five Star Medical Transportation LLC
• Timothy J Flanigan, D.D.S.
• Angela Flannery, MSE
• Ashley Michelle Flannery, MD

• Physical Therapy Assistant in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; 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.