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NPI Code Detail

MEDICARE: MRS. BEVERLY SPAAR PTA

MEDICARE:  MRS. BEVERLY  SPAAR  PTA
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
1225100000XPhysical Therapist88SC

General Provider Information

NPI Number : 1043305758
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BEVERLY SPAAR PTA
Provider Business Mailing Address
First Line : 50 SPAAR LN
Second Line :
City : SIMPSONVILLE
State : SC
Zip : 29680-7030
Country : US
Telephone Number : 864-963-5372
Fax Number :
Provider Business Practice Location Address
First Line : 850 E BUTLER RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-5842
Country : US
Telephone Number : 864-675-6421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. BEVERLY SPAAR PTA” Practice Location

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