Provider Demographics
NPI:1083800775
Name:TOM SEGAL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:TOM SEGAL PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-482-8007
Mailing Address - Street 1:9045 LA FONTANA BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5636
Mailing Address - Country:US
Mailing Address - Phone:561-482-8007
Mailing Address - Fax:
Practice Address - Street 1:9045 LA FONTANA BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5636
Practice Address - Country:US
Practice Address - Phone:561-482-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1398Medicare PIN