Provider Demographics
NPI:1841441516
Name:SPARGO, LINDIE (PT, ATC)
Entity type:Individual
Prefix:
First Name:LINDIE
Middle Name:
Last Name:SPARGO
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:LINDIE
Other - Middle Name:
Other - Last Name:HEMESATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:1025 E BROADWAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1535
Mailing Address - Country:US
Mailing Address - Phone:480-829-0217
Mailing Address - Fax:480-829-1410
Practice Address - Street 1:1025 E BROADWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1535
Practice Address - Country:US
Practice Address - Phone:480-829-0217
Practice Address - Fax:480-829-1410
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8237225100000X
PAPT0304582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ175576Medicare PIN
AZZ63123Medicare PIN