Provider Demographics
NPI:1215067368
Name:SPENCER, BRYANT EDWARD (LAT)
Entity type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:EDWARD
Last Name:SPENCER
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27600 KINGS MANOR DR
Mailing Address - Street 2:APT# 1222
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2156
Mailing Address - Country:US
Mailing Address - Phone:281-577-2800
Mailing Address - Fax:281-354-6813
Practice Address - Street 1:21650 LOOP 494
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-8240
Practice Address - Country:US
Practice Address - Phone:281-577-2800
Practice Address - Fax:281-354-6813
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT31932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer