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General NPI Number Information
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NPI Number | 1093490203
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Entity Type | Individual
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Provider Name | SPENCER THOMAS CUSHMAN
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Gender | Male
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 13370 E MARY ANN CLEVELAND WAY STE 130
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City | VAIL
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State | AZ
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Zip | 85641-8611
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Country | US
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Telephone | 520-689-7144
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E 120TH AVE
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City | NORTHGLENN
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State | CO
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Zip | 80233-1127
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Country | US
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Telephone | 303-280-3838
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Fax | 303-280-3838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305215852
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0020450
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License Number State | CO
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