Individual
BETHANY JEAN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
143 GRANDVIEW LN, ADDISON, VT 05491-8407
(802) 309-7401
Mailing address
143 GRANDVIEW LN, ADDISON, VT 05491-8407
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000036388
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2000036388
—
VT
Enumeration date
06/17/2019
Last updated
06/17/2019
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