Provider Demographics
NPI:1275503567
Name:FITZGIBBON, SINEAD (PT, PHD)
Entity Type:Individual
Prefix:
First Name:SINEAD
Middle Name:
Last Name:FITZGIBBON
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2333
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963
Mailing Address - Country:US
Mailing Address - Phone:631-484-5416
Mailing Address - Fax:
Practice Address - Street 1:34 BAY ST
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-3104
Practice Address - Country:US
Practice Address - Phone:631-725-4450
Practice Address - Fax:631-725-6206
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1717412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQK6151Medicare ID - Type Unspecified