Healthcare Provider Details

I. General information

NPI: 1689503674
Provider Name (Legal Business Name): SPENCER THOMAS HAYWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9852 BUSINESS PARK DR STE A
SACRAMENTO CA
95827-1709
US

IV. Provider business mailing address

9577 ROAN FIELDS PL
ELK GROVE CA
95624-6064
US

V. Phone/Fax

Practice location:
  • Phone: 916-362-7962
  • Fax:
Mailing address:
  • Phone: 916-479-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number49256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: