Provider Demographics
NPI:1508886599
Name:SEGAL, TOM J (PT)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:J
Last Name:SEGAL
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 1:9045 LA FONTANA BLVD
Mailing Address - Street 2:SUITE B-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:561-451-2365
Practice Address - Street 1:9045 LA FONTANA BLVD
Practice Address - Street 2:SUITE B-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:561-451-2365
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0004449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2460XMedicare PIN