=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407323561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SDS MEDICAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2018
-----------------------------------------------------
Last Update Date | 12/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5831 BEE RIDGE RD STE 300
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-5090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-284-8471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5831 BEE RIDGE RD STE 300
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-5090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-378-5100
-----------------------------------------------------
Fax | 941-960-1962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REHAB DIRECTOR
-----------------------------------------------------
Name | FANE F SIGAL
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 941-378-5100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------