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:
Health care specialties
| Specialty | Code | License # | 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 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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