Provider Demographics
NPI:1568649853
Name:SPENCER, KAREN SUE (MHS, PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6459 HIGHLAND LN
Mailing Address - Street 2:
Mailing Address - City:MC CORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9532
Mailing Address - Country:US
Mailing Address - Phone:317-709-6859
Mailing Address - Fax:317-336-6819
Practice Address - Street 1:6459 HIGHLAND LN
Practice Address - Street 2:
Practice Address - City:MC CORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9532
Practice Address - Country:US
Practice Address - Phone:317-709-6859
Practice Address - Fax:317-336-6819
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001609A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist