Healthcare Provider Details

I. General information

NPI: 1316772494
Provider Name (Legal Business Name): JESSICA MARIE SPOSATO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 PRIEST BRIDGE CT STE 7
CROFTON MD
21114-2463
US

IV. Provider business mailing address

2011 GOV THOMAS BLADEN WAY APT 303
ANNAPOLIS MD
21401-6971
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-6333
  • Fax:
Mailing address:
  • Phone: 410-487-5178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: