Provider Demographics
NPI:1467876912
Name:SPONAUGLE WELLNESS INSTITUTE
Entity Type:Organization
Organization Name:SPONAUGLE WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPONAUGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-945-9198
Mailing Address - Street 1:32815 US HWY 19 NORTH
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-945-9198
Mailing Address - Fax:727-945-1031
Practice Address - Street 1:32815 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3123
Practice Address - Country:US
Practice Address - Phone:727-945-9198
Practice Address - Fax:727-945-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45587261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty