Individual
MRS. ANN MARIE SPRAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5137
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
836420009
BC
—
01
—
J691808
PACIFIC SOURCE
—
01
—
R165938.
MEDICARE ID UNSPECIFIED
OR
Enumeration date
06/10/2006
Last updated
03/15/2024
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