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General NPI Number Information
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NPI Number | 1053779017
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Entity Type | Organization
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Legal Business Name | CRYSTAL SPENCER PHYSICAL THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 196 BLUE ASH DR
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City | SANDY HOOK
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State | KY
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Zip | 41171-7094
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Country | US
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Telephone | 606-424-0124
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Fax |
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Provider Business Mailing Address
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Address Line | 196 BLUE ASH DR
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City | SANDY HOOK
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State | KY
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Zip | 41171-7094
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | CRYSTAL SPENCER
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Credential | MSPT
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Telephone | 606-424-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 004988
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License Number State | KY
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