MEDICARE: MR. ANDREW E SPATAFORE MPT

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	2229	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790787992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW E SPATAFORE MPT

Provider Business Mailing Address
First Line	:	306 WEST MAIN STREET
Second Line	:
City	:	BRIDGEPORT
State	:	WV
Zip	:	26330
Country	:	US
Telephone Number	:	304-842-3137
Fax Number	:	304-842-3138

Provider Business Practice Location Address
First Line	:	306 WEST MAIN STREET
Second Line	:
City	:	BRIDGEPORT
State	:	WV
Zip	:	26330
Country	:	US
Telephone Number	:	304-842-3137
Fax Number	:	304-842-3138

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/03/2023

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Directions to “ MR. ANDREW E SPATAFORE MPT” Practice Location

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