Provider Demographics
NPI:1679251664
Name:SPENCER, MISHKA (DPT)
Entity Type:Individual
Prefix:
First Name:MISHKA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MISHKA
Other - Middle Name:
Other - Last Name:HARRISINGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:540 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1857
Practice Address - Country:US
Practice Address - Phone:248-675-8160
Practice Address - Fax:248-675-8161
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist