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General NPI Number Information
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NPI Number | 1982901765
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Entity Type | Individual
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Provider Name | MR. RICHARD SPENNER SR.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 931 NIAGARA LN
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1765
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Country | US
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Telephone | 414-333-3217
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Fax | 888-503-3706
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Provider Business Mailing Address
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Address Line | 931 NIAGARA LN
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1765
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Country | US
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Telephone | 414-333-3217
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Fax | 888-503-3706
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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 | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number | 02-04-05-025
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License Number State | WI
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