Provider Demographics
NPI:1518371574
Name:SPENCER, BRIANNE M (DPT)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PORTER DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1587
Mailing Address - Country:US
Mailing Address - Phone:925-838-1550
Mailing Address - Fax:925-838-2481
Practice Address - Street 1:200 PORTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1587
Practice Address - Country:US
Practice Address - Phone:925-838-1550
Practice Address - Fax:925-838-2481
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41344OtherMEDICAL LICENSE
CACA142511Medicare PIN
CACA142510Medicare PIN
CACA142509Medicare PIN