Provider Demographics
NPI:1073303863
Name:SPENCER, COLBY BLAKE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:COLBY
Middle Name:BLAKE
Last Name:SPENCER
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 JARRELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:DANA
Mailing Address - State:KY
Mailing Address - Zip Code:41615-9045
Mailing Address - Country:US
Mailing Address - Phone:606-424-7818
Mailing Address - Fax:
Practice Address - Street 1:175 WEDDINGTON BRANCH RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3204
Practice Address - Country:US
Practice Address - Phone:606-637-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist