Provider Demographics
NPI:1346643111
Name:BOWERS, SPENSER (MSC,ATC, CES)
Entity type:Individual
Prefix:MS
First Name:SPENSER
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MSC,ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7143 GATESHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1341
Mailing Address - Country:US
Mailing Address - Phone:818-439-0274
Mailing Address - Fax:
Practice Address - Street 1:21726 PLACERITA CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-1235
Practice Address - Country:US
Practice Address - Phone:661-362-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00010892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51345OtherNATIONAL ATHLETIC TRAINERS ASSOCIATION