Provider Demographics
NPI:1962741413
Name:SPERANZA, JACKIE (LPT)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:SPERANZA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 GRANTHAM CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6151
Mailing Address - Country:US
Mailing Address - Phone:770-329-8462
Mailing Address - Fax:
Practice Address - Street 1:2727 GRANTHAM CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6151
Practice Address - Country:US
Practice Address - Phone:770-329-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist