Provider Demographics
NPI:1447258702
Name:SPANGARO, PATRICIA A (PT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:SPANGARO
Suffix:
Gender:F
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:PO BOX 152474
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-2474
Mailing Address - Country:US
Mailing Address - Phone:239-246-2641
Mailing Address - Fax:239-458-9497
Practice Address - Street 1:2908 SW 5TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4605
Practice Address - Country:US
Practice Address - Phone:239-246-2641
Practice Address - Fax:239-458-9497
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0002340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4426OtherBLUE CROSS/ BLUE SHIELD