Provider Demographics
NPI:1447233739
Name:SOUTHWICK, SPENCER WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:WILLIAM
Last Name:SOUTHWICK
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 1:14201 NE 20TH AVE
Mailing Address - Street 2:SUITE 3101
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6410
Mailing Address - Country:US
Mailing Address - Phone:360-576-8599
Mailing Address - Fax:360-576-6320
Practice Address - Street 1:14201 NE 20TH AVE
Practice Address - Street 2:SUITE 3101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6410
Practice Address - Country:US
Practice Address - Phone:360-576-8599
Practice Address - Fax:360-576-6320
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT7684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist