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General NPI Number Information
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NPI Number | 1124609250
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Entity Type | Individual
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Provider Name | ELEANOR L SPENCER PTA
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Gender | Female
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 427 N MAGNOLIA AVE STE 100
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City | ORLANDO
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State | FL
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Zip | 32801-1524
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Country | US
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Telephone | 407-896-1152
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Fax |
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Provider Business Mailing Address
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Address Line | 4317 DINNER LAKE DR
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City | LAKE WALES
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State | FL
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Zip | 33859-2149
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Country | US
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Telephone | 740-856-1368
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 30920
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License Number State | FL
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