Provider Demographics
NPI:1093144727
Name:SPENCER, DONALD MASON II
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MASON
Last Name:SPENCER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 SARAH CT
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-8464
Mailing Address - Country:US
Mailing Address - Phone:989-450-4133
Mailing Address - Fax:
Practice Address - Street 1:500 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1313
Practice Address - Country:US
Practice Address - Phone:989-652-6101
Practice Address - Fax:989-652-3787
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001516225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant