Provider Demographics
NPI:1194984179
Name:SPANHEIMER, JENNIFER (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SPANHEIMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 SKYPOINTE DRIVE
Mailing Address - Street 2:#140-398
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131
Mailing Address - Country:US
Mailing Address - Phone:702-501-0325
Mailing Address - Fax:702-993-5400
Practice Address - Street 1:6440 SKYPOINTE DRIVE
Practice Address - Street 2:#140-398
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131
Practice Address - Country:US
Practice Address - Phone:702-501-0325
Practice Address - Fax:702-993-5400
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16442251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics