Provider Demographics
NPI:1164450284
Name:SCHRECKENGAUST, SPENCER S (DPT)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:S
Last Name:SCHRECKENGAUST
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 AVENIDA ENCINAS
Mailing Address - Street 2:STE E
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1005
Mailing Address - Country:US
Mailing Address - Phone:760-632-6942
Mailing Address - Fax:
Practice Address - Street 1:981 LOMAS SANTA FE DR
Practice Address - Street 2:STE A
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2144
Practice Address - Country:US
Practice Address - Phone:858-794-9995
Practice Address - Fax:858-794-9962
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT288541AMedicare ID - Type Unspecified
WPT28841BMedicare ID - Type Unspecified
WPT28841CMedicare ID - Type Unspecified
WPT28841Medicare ID - Type Unspecified