Healthcare Provider Details

I. General information

NPI: 1265468037
Provider Name (Legal Business Name): ANGELA MICHELLE SPENCER MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MANN MSPT

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 100TH ST
URBANDALE IA
50322-3865
US

IV. Provider business mailing address

3040 100TH ST
URBANDALE IA
50322-3865
US

V. Phone/Fax

Practice location:
  • Phone: 515-410-2908
  • Fax: 515-410-2909
Mailing address:
  • Phone: 515-720-9145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03497
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number03497
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: