Healthcare Provider Details

I. General information

NPI: 1992469779
Provider Name (Legal Business Name): ANNA SPENCE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 DEMANADE BLVD
LAFAYETTE LA
70503-2508
US

IV. Provider business mailing address

207 BENTWATER DR
BROUSSARD LA
70518-4581
US

V. Phone/Fax

Practice location:
  • Phone: 318-548-3925
  • Fax:
Mailing address:
  • Phone: 318-548-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number10919
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: