MEDICARE: TANNER EDWARD SPENCER

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	5502008959	MI

General Provider Information

NPI Number	:	1881546711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER EDWARD SPENCER

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	928 E 10 MILE RD STE 100
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-3041
Country	:	US
Telephone Number	:	248-621-5650
Fax Number	:	248-621-5651

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ TANNER EDWARD SPENCER ” Practice Location

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