Provider Demographics
NPI:1407037948
Name:SPIROFF, RICHARD EDWARD (MSPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:SPIROFF
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3242
Mailing Address - Country:US
Mailing Address - Phone:305-245-4905
Mailing Address - Fax:305-245-9819
Practice Address - Street 1:2004 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3242
Practice Address - Country:US
Practice Address - Phone:305-245-4905
Practice Address - Fax:305-245-9819
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09133OtherWELLCARE
FL2600694OtherCIGNA
FL09133OtherSTAYWELL
FL2381101OtherUNITED HEALTHCARE
FLY8763Medicare UPIN