Provider Demographics
NPI:1265468037
Name:SPENCER, ANGELA MICHELLE (MSPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:3040 100TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3865
Mailing Address - Country:US
Mailing Address - Phone:515-720-9145
Mailing Address - Fax:
Practice Address - Street 1:3030 100TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3865
Practice Address - Country:US
Practice Address - Phone:515-410-2908
Practice Address - Fax:515-410-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA034972251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic