Provider Demographics
NPI:1093320343
Name:SPENCE, TERRENCE (LMT)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:SPENCE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 GRIFFITH ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2149
Mailing Address - Country:US
Mailing Address - Phone:201-467-3092
Mailing Address - Fax:
Practice Address - Street 1:134 GRIFFITH ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2149
Practice Address - Country:US
Practice Address - Phone:201-467-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77993225700000X
NJ18KT01006000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist