Provider Demographics
NPI:1235304908
Name:SIGAFOOS, LAWRENCE II (PTA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:SIGAFOOS
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W GRANADA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5103
Mailing Address - Country:US
Mailing Address - Phone:386-846-1143
Mailing Address - Fax:386-677-7463
Practice Address - Street 1:545 W GRANADA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5103
Practice Address - Country:US
Practice Address - Phone:386-846-1143
Practice Address - Fax:386-677-7463
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18804225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant