Provider Demographics
NPI:1982867743
Name:SPENCER, JENNIFER SELF (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SELF
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LOREN
Other - Last Name:SELF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1217 WILLOW LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4131
Mailing Address - Country:US
Mailing Address - Phone:205-602-1848
Mailing Address - Fax:205-293-3895
Practice Address - Street 1:3075 JOHN HAWKINS PKWY STE J
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-7003
Practice Address - Country:US
Practice Address - Phone:205-202-0874
Practice Address - Fax:205-293-3895
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL62242251X0800X
ALPTH6224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I700021Medicare PIN