Individual
MR. JESSE MATTHEW FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
228 NEWHALL ST, GREEN BAY, WI 54302-1708
(715) 651-7382
Mailing address
228 NEWHALL ST, GREEN BAY, WI 54302-1708
(715) 651-7382
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1533-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100033830
—
WI
Enumeration date
11/07/2013
Last updated
03/05/2015
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