Provider Demographics
NPI:1578686887
Name:SPICER, LIBBY LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:LOUISE
Last Name:SPICER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33396
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-0396
Mailing Address - Country:US
Mailing Address - Phone:440-230-1133
Mailing Address - Fax:440-230-9243
Practice Address - Street 1:5340 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4008
Practice Address - Country:US
Practice Address - Phone:440-230-1133
Practice Address - Fax:440-230-9243
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR48562251X0800X
OHPT009516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SP4216062Medicare PIN
OHSP4216061Medicare PIN