Provider Demographics
NPI:1285610360
Name:PIGNATELLO, DAVID J (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:PIGNATELLO
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 1:5088 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3120
Mailing Address - Country:US
Mailing Address - Phone:727-541-2675
Mailing Address - Fax:727-541-3956
Practice Address - Street 1:5088 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-3120
Practice Address - Country:US
Practice Address - Phone:727-541-2675
Practice Address - Fax:727-541-3956
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005375111N00000X
FLPT2257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050218901Medicaid
FL050218900Medicaid
FL050218901Medicaid