Provider Demographics
NPI:1821400250
Name:SPENCER, GYPSY LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:GYPSY
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NEW KING ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1205
Mailing Address - Country:US
Mailing Address - Phone:914-390-9880
Mailing Address - Fax:914-390-9881
Practice Address - Street 1:419 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2756
Practice Address - Country:US
Practice Address - Phone:615-348-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5070225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant