Provider Demographics
NPI:1427720846
Name:LYNASS, SPENSER (PT, DPT)
Entity type:Individual
Prefix:
First Name:SPENSER
Middle Name:
Last Name:LYNASS
Suffix:
Gender:M
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 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:
Practice Address - Street 1:6169 S BALSAM WAY
Practice Address - Street 2:STE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3000
Practice Address - Country:US
Practice Address - Phone:303-948-1868
Practice Address - Fax:303-948-1741
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6052225100000X
COPTL.0019064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1427720846Medicaid