MEDICARE: MS. PATRICIA A SPANGARO P.T.

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	225100000X	Physical Therapist	PT0002340	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y4426	OTHER	FL	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1447258702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA A SPANGARO P.T.

Provider Business Mailing Address
First Line	:	PO BOX 152474
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33915-2474
Country	:	US
Telephone Number	:	239-246-2641
Fax Number	:	239-458-9497

Provider Business Practice Location Address
First Line	:	2908 SW 5TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4605
Country	:	US
Telephone Number	:	239-246-2641
Fax Number	:	239-458-9497

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/09/2007

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