MEDICARE: FRANKIE SPARACIA 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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	PT29724	FL

General Provider Information

NPI Number	:	1215339064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANKIE SPARACIA DPT

Provider Business Mailing Address
First Line	:	236 PONTE VEDRA PARK DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6619
Country	:	US
Telephone Number	:	904-280-3440
Fax Number	:	904-280-3444

Provider Business Practice Location Address
First Line	:	236 PONTE VEDRA PARK DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6619
Country	:	US
Telephone Number	:	904-280-3440
Fax Number	:	904-280-3444

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

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/24/2014

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