Provider Demographics
NPI:1487005658
Name:GILL, SPENCER PATRICK (LAT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:PATRICK
Last Name:GILL
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 MORRIS WAY DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-7270
Mailing Address - Country:US
Mailing Address - Phone:803-840-2178
Mailing Address - Fax:
Practice Address - Street 1:1115 MORRIS WAY DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-7270
Practice Address - Country:US
Practice Address - Phone:803-840-2178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer