Provider Demographics
NPI:1043870074
Name:BARON, SPENCER (PT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:BARON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CIRCLE 75 PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3064
Mailing Address - Country:US
Mailing Address - Phone:678-403-3568
Mailing Address - Fax:
Practice Address - Street 1:3991 HIGHWAY 78 W STE 200
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3929
Practice Address - Country:US
Practice Address - Phone:470-482-6933
Practice Address - Fax:470-482-6940
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist