Provider Demographics
NPI:1669662573
Name:SPENCER, LISA KATHRYN (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:KATHRYN
Last Name:SPENCER
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 1:1154 BRINKLEY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8579
Mailing Address - Country:US
Mailing Address - Phone:615-452-8833
Mailing Address - Fax:
Practice Address - Street 1:813 SOUTH DICKERSON ROAD
Practice Address - Street 2:
Practice Address - City:GOODLETSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072
Practice Address - Country:US
Practice Address - Phone:615-859-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist