Provider Demographics
NPI:1164545414
Name:SPENCER, MADELEINE ADELE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:ADELE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:ADELE
Other - Last Name:D'AMICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:1075 VIRGINIA DR STE 200
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3108
Practice Address - Country:US
Practice Address - Phone:215-619-4545
Practice Address - Fax:215-619-4555
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-013454-L171W00000X
PAPT013454L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor