MEDICARE: SUSAN DERIAN 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	225100000X	Physical Therapist	1006682	TX

General Provider Information

NPI Number	:	1730643214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DERIAN SPENCER PT

Provider Business Mailing Address
First Line	:	13142 N HUNTERS CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2843
Country	:	US
Telephone Number	:	512-584-0515
Fax Number	:

Provider Business Practice Location Address
First Line	:	13142 N HUNTERS CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2843
Country	:	US
Telephone Number	:	210-860-5478
Fax Number	:

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

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	01/29/2019

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Directions to “ SUSAN DERIAN SPENCER PT” Practice Location

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