Individual
JACK ANTHONY SPATAFORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT/MS
Contact information
Practice address
306 W MAIN ST, BRIDGEPORT, WV 26330-1751
(304) 842-3137
(304) 842-3138
Mailing address
306 W MAIN ST, BRIDGEPORT, WV 26330-1751
(304) 842-3137
(304) 842-3138
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
002038
WV
225100000X
Physical Therapist
002038
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01071873100
WV WORKERS' COMPENSATION
WV
01
—
010718731004
BLUE CROSS
WV
01
—
135810
HEALTH ASSURANCE
WV
01
—
1382862
UMWA
WV
01
—
398789
OPTIMUM CHOICE
WV
01
—
650023875
RAILROAD MEDICARE
WV
01
—
701615
AETNA
WV
05
—
7305012-001
—
WV
01
—
WV51916B
HEALTH PLAN
WV
Enumeration date
06/28/2005
Last updated
03/25/2009
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