Healthcare Provider Details

I. General information

NPI: 1174089916
Provider Name (Legal Business Name): SPENCER BRYANT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 RED BANK RD
CINCINNATI OH
45227-3429
US

IV. Provider business mailing address

731 KELLEY LN
SANDUSKY OH
44870-7361
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-4011
  • Fax: 513-389-3665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017879
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: