Provider Demographics
NPI:1003463860
Name:SUS-SPENCER ENTERPRISES LLC
Entity Type:Organization
Organization Name:SUS-SPENCER ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:469-476-2423
Mailing Address - Street 1:930 E 15TH ST APT 435
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5873
Mailing Address - Country:US
Mailing Address - Phone:214-620-3773
Mailing Address - Fax:
Practice Address - Street 1:9319 LBJ FWY STE 208C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3453
Practice Address - Country:US
Practice Address - Phone:469-476-2423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty