Healthcare Provider Details

I. General information

NPI: 1578686887
Provider Name (Legal Business Name): LIBBY LOUISE SPICER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 ROYALTON RD
NORTH ROYALTON OH
44133-4008
US

IV. Provider business mailing address

PO BOX 33396
NORTH ROYALTON OH
44133-0396
US

V. Phone/Fax

Practice location:
  • Phone: 440-230-1133
  • Fax: 440-230-9243
Mailing address:
  • Phone: 440-230-1133
  • Fax: 440-230-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009516
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4856
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: