Provider Demographics
NPI:1578555728
Name:SPURLOCK, JOAN LITTIKEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:LITTIKEN
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:L
Other - Last Name:LITTIKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6080 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3912
Mailing Address - Country:US
Mailing Address - Phone:817-731-9331
Mailing Address - Fax:817-731-9882
Practice Address - Street 1:6080 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3912
Practice Address - Country:US
Practice Address - Phone:817-731-9331
Practice Address - Fax:817-731-9882
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81080TOtherBCBS TX
TX800T11Medicare ID - Type UnspecifiedMEDICARE / CMS