Provider Demographics
NPI:1457735656
Name:CONNELL, SPENCER ANDREW (DAT, ATC)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:ANDREW
Last Name:CONNELL
Suffix:
Gender:M
Credentials:DAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 E WESTFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1830
Mailing Address - Country:US
Mailing Address - Phone:302-750-2177
Mailing Address - Fax:
Practice Address - Street 1:349 E WESTFIELD BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1830
Practice Address - Country:US
Practice Address - Phone:302-750-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer