Individual
MS. TARA LEWIS FITZPATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 INTERSTATE PARK DR, MONTGOMERY, AL 36109-5408
(334) 395-5100
Mailing address
301 INTERSTATE PARK DR, MONTGOMERY, AL 36109-5408
(334) 395-5100
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
17120
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51532109
BLUE CROSS BLUE SHIELD
AL
Enumeration date
10/04/2006
Last updated
06/12/2008
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