Spatafore, Jack Anthony

Spatafore, Jack Anthony is an individual health care provider with primary practice located at 306 W Main St , Bridgeport WV 26330-1751. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist. Other Service Providers / Specialist is his primary health care specialty. Spatafore, Jack Anthony can be contacted via phone (304) 842-3137.

Contact Information

Primary practice address
306 W Main St Bridgeport WV 26330-1751
Phone: (304) 842-3137
Fax: (304) 842-3138
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 002038 West Virginia
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 002038 West Virginia

Profile Details

NPI number 1093711657
LBN Legal business name Spatafore, Jack Anthony
Credentials DPT/MS
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2005
Last updated Mar 25th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093711657 NPPES
West Virginia Other 01071873100 WV WORKERS' COMPENSATION
West Virginia Other 1382862 WV WORKERS' COMPENSATION
West Virginia MEDICAID 7305012-001 WV WORKERS' COMPENSATION
West Virginia Other WV51916B WV WORKERS' COMPENSATION
West Virginia Other 701615 WV WORKERS' COMPENSATION
West Virginia Other 650023875 WV WORKERS' COMPENSATION
West Virginia Other 010718731004 WV WORKERS' COMPENSATION
West Virginia Other 135810 WV WORKERS' COMPENSATION
West Virginia Other 398789 WV WORKERS' COMPENSATION

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