Provider Demographics
NPI:1568863975
Name:SPATARO, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SPATARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 NW 87TH TER STE 210
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-3706
Mailing Address - Country:US
Mailing Address - Phone:816-226-7843
Mailing Address - Fax:816-583-0954
Practice Address - Street 1:7280 NW 87TH TER STE 210
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-3706
Practice Address - Country:US
Practice Address - Phone:816-226-7843
Practice Address - Fax:816-583-0954
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1247059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88TT58OtherBCBS
TX338159201Medicaid