MEDICARE: STEPHANIE SPROUT DPT

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	225100000X	Physical Therapist	PT 30162	FL

General Provider Information

NPI Number	:	1326407487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SPROUT DPT

Provider Business Mailing Address
First Line	:	2719 SW 19TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-1929
Country	:	US
Telephone Number	:	603-387-4553
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 VIRGINIA ST
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-5220
Country	:	US
Telephone Number	:	305-446-6899
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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Directions to “ STEPHANIE SPROUT DPT” Practice Location

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