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General NPI Number Information
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NPI Number | 1730643214
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Entity Type | Individual
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Provider Name | SUSAN DERIAN SPENCER PT
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Gender | Female
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 13142 N HUNTERS CIR
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City | SAN ANTONIO
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State | TX
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Zip | 78230-2843
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Country | US
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Telephone | 210-860-5478
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Fax |
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Provider Business Mailing Address
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Address Line | 13142 N HUNTERS CIR
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City | SAN ANTONIO
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State | TX
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Zip | 78230-2843
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Country | US
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Telephone | 512-584-0515
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1006682
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License Number State | TX
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