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General NPI Number Information
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NPI Number | 1467026591
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Entity Type | Individual
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Provider Name | SPENCER EDWARDS DPT
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Gender | Male
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 126 E MAIN ST STE C
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City | PAYSON
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State | AZ
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Zip | 85541-5488
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Country | US
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Telephone | 928-468-8907
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Fax |
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Provider Business Mailing Address
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Address Line | 512 W LONGHORN RD UNIT 2
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City | PAYSON
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State | AZ
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Zip | 85541-4344
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Country | US
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Telephone | 801-602-7754
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | LPT-31746
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License Number State | AZ
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