Provider Demographics
NPI:1225572357
Name:SPENCER, SARAH M (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:SPENCER
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 1:2 MOUNTAIN ASH AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-9376
Mailing Address - Country:US
Mailing Address - Phone:201-563-1971
Mailing Address - Fax:
Practice Address - Street 1:11 BOWDOIN MILL IS
Practice Address - Street 2:#220
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1263
Practice Address - Country:US
Practice Address - Phone:207-729-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist