Provider Demographics
NPI:1104872043
Name:SIGAL, FANE (PT)
Entity type:Individual
Prefix:
First Name:FANE
Middle Name:
Last Name:SIGAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9206
Mailing Address - Country:US
Mailing Address - Phone:941-375-8624
Mailing Address - Fax:888-375-9314
Practice Address - Street 1:436 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9206
Practice Address - Country:US
Practice Address - Phone:941-375-8624
Practice Address - Fax:888-375-9314
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY056DAMedicare ID - Type Unspecified