Provider Demographics
NPI:1235676784
Name:SPENCER, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SPENCER
Suffix:
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 1:8214 E WHITTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5824
Mailing Address - Country:US
Mailing Address - Phone:602-888-9348
Mailing Address - Fax:602-563-6810
Practice Address - Street 1:3744 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5129
Practice Address - Country:US
Practice Address - Phone:602-888-9348
Practice Address - Fax:602-563-6810
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist