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General NPI Number Information
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NPI Number | 1962192344
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Entity Type | Individual
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Provider Name | SPENCER BROTHERS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 700 BLUE RIDGE AVE
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City | BELTON
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State | SC
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Zip | 29627-2302
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Country | US
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Telephone | 864-964-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 CLOUD DR
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City | BELTON
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State | SC
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Zip | 29627-9423
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Country | US
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Telephone |
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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 | 11838
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License Number State | SC
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