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General NPI Number Information
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NPI Number | 1467876912
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Entity Type | Organization
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Legal Business Name | SPONAUGLE WELLNESS INSTITUTE
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 32815 US HIGHWAY 19 N
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City | PALM HARBOR
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State | FL
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Zip | 34684-3123
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Country | US
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Telephone | 727-945-9198
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Fax | 727-945-1031
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Provider Business Mailing Address
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Address Line | 32815 US HWY 19 NORTH
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City | PALM HARBOR
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State | FL
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Zip | 34684
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Country | US
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Telephone | 727-945-9198
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Fax | 727-945-1031
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARVIN R SPONAUGLE
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Credential | MD
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Telephone | 727-945-9198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME45587
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License Number State | FL
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