Provider Demographics
NPI:1619588035
Name:COX, SPENCER (PTA)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:COX
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 E DISCOVERY PKWY APT D102
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9031
Mailing Address - Country:US
Mailing Address - Phone:812-774-7688
Mailing Address - Fax:
Practice Address - Street 1:800 N BELL TRACE CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-4405
Practice Address - Country:US
Practice Address - Phone:812-332-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2151091225200000X
IN06005979A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant