Provider Demographics
NPI:1235432063
Name:SPARACIO PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:SPARACIO PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SPARACIO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT COMT CFMT
Authorized Official - Phone:516-439-5656
Mailing Address - Street 1:3 SCHOOL ST STE 205
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-676-2327
Mailing Address - Fax:516-676-4960
Practice Address - Street 1:3 SCHOOL ST STE 205
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-676-2327
Practice Address - Fax:516-676-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014956261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy