Provider Demographics
NPI:1639421795
Name:SPENCER, ASHLEY CECIL
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CECIL
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 MEDICAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1413
Mailing Address - Country:US
Mailing Address - Phone:239-566-3434
Mailing Address - Fax:239-566-2143
Practice Address - Street 1:1660 MEDICAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1413
Practice Address - Country:US
Practice Address - Phone:239-566-3434
Practice Address - Fax:239-566-2143
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40935BMedicare PIN
FL40935Medicare PIN