Provider Demographics
NPI:1164546560
Name:SPONAUGLE, CAROLE SUSSI (PT)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:SUSSI
Last Name:SPONAUGLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2415
Mailing Address - Country:US
Mailing Address - Phone:717-396-9844
Mailing Address - Fax:
Practice Address - Street 1:600 EDEN ROAD
Practice Address - Street 2:BUILDING I
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4205
Practice Address - Country:US
Practice Address - Phone:717-299-4829
Practice Address - Fax:717-295-3453
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008757E2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018895510001Other17