Provider Demographics
NPI:1467561522
Name:SPENCER, ANDREA S (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2784 S COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9312
Mailing Address - Country:US
Mailing Address - Phone:937-332-9084
Mailing Address - Fax:937-332-9130
Practice Address - Street 1:2784 S COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-9312
Practice Address - Country:US
Practice Address - Phone:937-332-9084
Practice Address - Fax:937-332-9130
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2631745Medicaid
OHSP4165121Medicare ID - Type Unspecified