Provider Demographics
NPI:1851667828
Name:SPILLMAN, ANTHOPNY (PTA)
Entity Type:Individual
Prefix:
First Name:ANTHOPNY
Middle Name:
Last Name:SPILLMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 W YOWELL CT
Mailing Address - Street 2:#40
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-1730
Mailing Address - Country:US
Mailing Address - Phone:928-301-9128
Mailing Address - Fax:
Practice Address - Street 1:2470 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8520
Practice Address - Country:US
Practice Address - Phone:928-344-8541
Practice Address - Fax:928-344-0823
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9072A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility