MEDICARE: PATRICIA LUCY SPADA-ELMASIAN 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	PT 16356	FL

General Provider Information

NPI Number	:	1457472821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LUCY SPADA-ELMASIAN P.T.

Provider Business Mailing Address
First Line	:	1009 SE KITCHING COVE LN
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5902
Country	:	US
Telephone Number	:	772-398-8869
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 SE LYNGATE DR
Second Line	:	SUITE 203
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-4300
Country	:	US
Telephone Number	:	772-335-7966
Fax Number	:	772-335-7963

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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