Provider Demographics
NPI:1306177860
Name:SPANGLER, GREGORY SCOTT (PTA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SCOTT
Last Name:SPANGLER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:
Other - Last Name:SPANGLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:4325 NE 2ND CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-1978
Mailing Address - Country:US
Mailing Address - Phone:352-732-6773
Mailing Address - Fax:
Practice Address - Street 1:4325 NE 2ND CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-1978
Practice Address - Country:US
Practice Address - Phone:352-732-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17958225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant