Provider Demographics
NPI:1639965239
Name:SPENCER, GINGER DIANE
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:DIANE
Last Name:SPENCER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7282 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-5181
Mailing Address - Country:US
Mailing Address - Phone:804-832-8859
Mailing Address - Fax:
Practice Address - Street 1:7282 YORK AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5181
Practice Address - Country:US
Practice Address - Phone:804-832-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019004282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist