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General NPI Number Information
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NPI Number | 1891343778
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Entity Type | Individual
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Provider Name | DENNIS SPIVEY PTA
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Gender | Male
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 3905 LORRAINE PATH
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8630
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Country | US
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Telephone | 269-428-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 209 D ST
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City | LA PORTE
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State | IN
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Zip | 46350-4933
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Country | US
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Telephone | 219-379-7365
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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 | 5502001518
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License Number State | MI
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