Provider Demographics
NPI:1407111867
Name:SPENCER, RICHARD L JR (DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:SPENCER
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2038
Mailing Address - Country:US
Mailing Address - Phone:918-622-4126
Mailing Address - Fax:918-270-2398
Practice Address - Street 1:200 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7638
Practice Address - Country:US
Practice Address - Phone:918-245-0111
Practice Address - Fax:918-245-3555
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist