Provider Demographics
NPI:1932545688
Name:SPICER, AMY JO (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:SPICER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 RIGGIN RD
Mailing Address - Street 2:
Mailing Address - City:MARDELA SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21837
Mailing Address - Country:US
Mailing Address - Phone:443-235-2710
Mailing Address - Fax:
Practice Address - Street 1:9375 RIGGIN RD
Practice Address - Street 2:
Practice Address - City:MARDELA SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:21837
Practice Address - Country:US
Practice Address - Phone:443-235-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist