Provider Demographics
NPI:1952764128
Name:WILLIAMSON, SPENCER (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 ZIONSVILLE RD STE 800
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5128
Mailing Address - Country:US
Mailing Address - Phone:317-536-4870
Mailing Address - Fax:844-261-5625
Practice Address - Street 1:1032 W VAUGHN ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5446
Practice Address - Country:US
Practice Address - Phone:480-226-2224
Practice Address - Fax:844-261-5625
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer