Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 006870 | NY |
NPI | 1003277716 |
---|---|
Provider Name | Thomas P Spagnoli |
First Address | Southampton, NY 11968-4823 |
Second Address | Southampton, NY 11968-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2016 |
Last Update Date | 09/03/2016 |