Provider Demographics
NPI:1851639439
Name:SPENCER, GORDON (LMT)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ULUNIU ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2529
Mailing Address - Country:US
Mailing Address - Phone:808-261-8181
Mailing Address - Fax:808-261-7770
Practice Address - Street 1:320 ULUNIU ST
Practice Address - Street 2:SIUTE 2
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2529
Practice Address - Country:US
Practice Address - Phone:808-261-8181
Practice Address - Fax:808-261-7770
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist