Provider Demographics
NPI:1134367238
Name:SPENCE, JOSHUA FRANKLIN (LMT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:FRANKLIN
Last Name:SPENCE
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 1:635 S WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1436
Mailing Address - Country:US
Mailing Address - Phone:321-507-8070
Mailing Address - Fax:321-723-1110
Practice Address - Street 1:635 S WICKHAM RD
Practice Address - Street 2:
Practice Address - City:W MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1436
Practice Address - Country:US
Practice Address - Phone:321-507-8070
Practice Address - Fax:321-723-1110
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54630225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist