Provider Demographics
NPI:1568165587
Name:SPENCER, GARRETT TODD (PT)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:TODD
Last Name:SPENCER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:153 W 27TH ST STE 1204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6250
Mailing Address - Country:US
Mailing Address - Phone:646-875-8348
Mailing Address - Fax:212-989-2708
Practice Address - Street 1:1801 MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:LAKE COMO
Practice Address - State:NJ
Practice Address - Zip Code:07719-2972
Practice Address - Country:US
Practice Address - Phone:732-390-8100
Practice Address - Fax:732-626-6767
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY049650208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation