MEDICARE: GARRETT TODD SPENCER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	049650	NY

General Provider Information

NPI Number	:	1568165587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT TODD SPENCER PT

Provider Business Mailing Address
First Line	:	153 W 27TH ST STE 1204
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6250
Country	:	US
Telephone Number	:	646-875-8348
Fax Number	:	212-989-2708

Provider Business Practice Location Address
First Line	:	1801 MAIN ST STE 1B
Second Line	:
City	:	LAKE COMO
State	:	NJ
Zip	:	07719-2972
Country	:	US
Telephone Number	:	732-390-8100
Fax Number	:	732-626-6767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	05/02/2024

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