Provider Demographics
NPI:1326081712
Name:SPALDING, MICHAEL S (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:SPALDING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CROSSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1845
Mailing Address - Country:US
Mailing Address - Phone:502-223-7403
Mailing Address - Fax:502-223-5016
Practice Address - Street 1:115 CROSSFIELD DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1845
Practice Address - Country:US
Practice Address - Phone:502-223-7403
Practice Address - Fax:502-223-5016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6424Medicare ID - Type Unspecified