Provider Demographics
NPI:1750396214
Name:SPADINO, PAUL A (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:SPADINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:4301 PENN AVE
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1370
Practice Address - Country:US
Practice Address - Phone:610-927-4136
Practice Address - Fax:610-927-4139
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012605L225100000X
DEJ10002287225100000X
NJ40QA01267900225100000X
NJ22403225100000X
MN4523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1750396214OtherDPCI
DE1750396214Medicaid
PA513005OtherFREEDOM BLUE
PA001756143Medicaid
PA0297366000OtherIBC
PA30062590OtherKEYSTONE MERCY
PA50087548OtherCAPITAL BLUE CROSS
PA513005OtherHIGHMARK PABS
000000250166OtherAMERICHOICE
1750396214OtherBRAVO
PAP00692884OtherMEDICARE RAILROAD
PA124159YENFMedicare PIN
PA124159VLZMedicare PIN
1750396214OtherBRAVO