| Doctor Name: | MR. JACK JOSEPH SPARACIO |
| NPI Number: | 1780662163 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSPT COMT CFMT |
| License Number: | 0149561 |
| Business Practice Address: | 1165 Northern Blvd Suite #403 Manhasset, NY - 11030 |
| Business Phone Number: | 5166762327 |
| Business Fax Number: | 5166764960 |
| Mailing Address: | 70 Forest Ave, Suite #2a GLEN COVE |
| State: | NY |
| Postal Code: | 11542 |
| Phone Number: | 5166762327 |
| Fax Number: | 5166764960 |
| NPI Enumeration Date: | 01/05/2006 |
| NPI Last Update Date: | 04/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 0149561 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |