Provider Demographics
NPI:1467576074
Name:SINCLAIR, JOANNE G (PTA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:G
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 PHOEBENEST DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-1786
Mailing Address - Country:US
Mailing Address - Phone:813-571-0831
Mailing Address - Fax:
Practice Address - Street 1:414 CHAPMAN RD E
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5779
Practice Address - Country:US
Practice Address - Phone:813-948-0612
Practice Address - Fax:813-909-2872
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 19293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBBJL6PKAOtherAETNA HEALTH INS.
FLPTA 19293OtherPHYSICAL THERAPIST ASST