Provider Demographics
NPI:1871699090
Name:FITZPATRICK, LAURA FAITH (PT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:FAITH
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:FAITH
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:360-352-2037
Mailing Address - Fax:360-464-4851
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-7733
Practice Address - Country:US
Practice Address - Phone:253-968-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA226119OtherL & I
WA2586FIOtherREGENCE
WA8496747OtherDSHS
WA2586FIOtherREGENCE