Provider Demographics
NPI:1396850574
Name:SPENCER, KATE VIOLETTE (PT, DPT, OCS, CSCS)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:VIOLETTE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4330
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81612-4330
Mailing Address - Country:US
Mailing Address - Phone:617-538-1443
Mailing Address - Fax:
Practice Address - Street 1:11421 OLD GLENN HWY
Practice Address - Street 2:STE 101
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7729
Practice Address - Country:US
Practice Address - Phone:617-538-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18220225100000X
AK24292251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist