Provider Demographics
NPI:1740762475
Name:SPENCER, ROBIN (ROBIN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ROBIN
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 STEEL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5173
Mailing Address - Country:US
Mailing Address - Phone:281-813-8443
Mailing Address - Fax:
Practice Address - Street 1:1003 BECKETT STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1372
Practice Address - Country:US
Practice Address - Phone:210-998-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2057603225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant