Healthcare Provider Details

I. General information

NPI: 1538461694
Provider Name (Legal Business Name): SPENCER WAYNE HUTCHINS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 12TH AVE N
SAINT PETERSBURG FL
33701-1120
US

IV. Provider business mailing address

412 12TH AVE N
ST PETERSBURG FL
33701-1120
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-5001
  • Fax: 727-894-0554
Mailing address:
  • Phone: 727-898-5001
  • Fax: 727-894-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: