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General NPI Number Information
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NPI Number | 1336624519
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Entity Type | Individual
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Provider Name | JORDAN SPENCER PT
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Gender | Male
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 1110 MAIN STREET
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City | HARRINGTON
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State | ME
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Zip | 04643
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Country | US
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Telephone | 207-483-4022
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Fax | 207-483-9722
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | HARRINGTON
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State | ME
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Zip | 04643-0220
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Country | US
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Telephone | 207-483-4022
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Fax | 207-483-9722
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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 | 4954
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License Number State | ME
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