MEDICARE: SPENCER DABBS

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	225200000X	Physical Therapy Assistant	25689	FL

General Provider Information

NPI Number	:	1700251204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER DABBS

Provider Business Mailing Address
First Line	:	4791 S ATLANTIC AVE UNIT 8
Second Line	:
City	:	PONCE INLET
State	:	FL
Zip	:	32127-7162
Country	:	US
Telephone Number	:	901-219-1821
Fax Number	:

Provider Business Practice Location Address
First Line	:	4791 S ATLANTIC AVE UNIT 8
Second Line	:
City	:	PONCE INLET
State	:	FL
Zip	:	32127-7162
Country	:	US
Telephone Number	:	901-219-1821
Fax Number	:

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

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	12/09/2015

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Directions to “ SPENCER DABBS ” Practice Location

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