Provider Demographics
NPI:1275712523
Name:SPENCER, JENNIE J (PT)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:J
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:J
Other - Last Name:WELLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:773 EAST ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3033
Mailing Address - Country:US
Mailing Address - Phone:810-664-3000
Mailing Address - Fax:810-664-9775
Practice Address - Street 1:773 EAST ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3033
Practice Address - Country:US
Practice Address - Phone:810-664-3000
Practice Address - Fax:810-664-9775
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist