Healthcare Provider Details

I. General information

NPI: 1235101155
Provider Name (Legal Business Name): JENNIFER ANN SPITZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN WIGINGTON

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 NORTH MAIN ST
NATICK MA
01760
US

IV. Provider business mailing address

310 N MOUND ST
NACOGDOCHES TX
75961-5032
US

V. Phone/Fax

Practice location:
  • Phone: 781-400-4644
  • Fax: 781-431-9152
Mailing address:
  • Phone: 936-560-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: