Provider Demographics
NPI:1598049918
Name:SHUGART, SPENCER D (MPT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:D
Last Name:SHUGART
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 MACON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2652
Mailing Address - Country:US
Mailing Address - Phone:478-987-4600
Mailing Address - Fax:844-308-4986
Practice Address - Street 1:1306 MACON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2652
Practice Address - Country:US
Practice Address - Phone:478-987-4600
Practice Address - Fax:844-308-4986
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13345225100000X
GAPT010464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist