Healthcare Provider Details

I. General information

NPI: 1184651259
Provider Name (Legal Business Name): JAMES KEITH SPITZER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N CENTER ST
VERSAILLES OH
45380-1206
US

IV. Provider business mailing address

147 N CENTER ST
VERSAILLES OH
45380-1206
US

V. Phone/Fax

Practice location:
  • Phone: 937-526-5262
  • Fax: 937-526-5267
Mailing address:
  • Phone: 937-526-5262
  • Fax: 937-526-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8577
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: