=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881672087
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT SPAGNOLI P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2006
-----------------------------------------------------
Last Update Date | 01/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 MARK TREE RD
-----------------------------------------------------
City | CENTEREACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11720-2221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-467-4235
-----------------------------------------------------
Fax | 631-467-2655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 BIRCH HOLLOW CT
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11790-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-467-4235
-----------------------------------------------------
Fax | 631-467-2655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 008859-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------