MEDICARE: SINEAD FITZGIBBON PT, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	171741	UT

General Provider Information

NPI Number	:	1275503567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SINEAD FITZGIBBON PT, PHD

Provider Business Mailing Address
First Line	:	PO BOX 2333
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963
Country	:	US
Telephone Number	:	631-484-5416
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 BAY ST
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-3104
Country	:	US
Telephone Number	:	631-725-4450
Fax Number	:	631-725-6206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/08/2020

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