Provider Demographics
NPI:1841368644
Name:ELLIOTT, SPENCER DOUGLAS (MA, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:DOUGLAS
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6176 NEPTUNE ROAD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8182
Mailing Address - Country:US
Mailing Address - Phone:704-564-6847
Mailing Address - Fax:
Practice Address - Street 1:NOVANT HEALTH PERRY & COOK ORTHOPEDICS & SPORTS MEDICIN
Practice Address - Street 2:2826 RANDOLPH ROAD
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1386
Practice Address - Country:US
Practice Address - Phone:704-358-0308
Practice Address - Fax:704-358-0039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC11952255A2300X
NC11442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer