Provider Demographics
NPI:1588049316
Name:EARNEST, SPENCER
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:EARNEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5871
Mailing Address - Country:US
Mailing Address - Phone:702-564-6712
Mailing Address - Fax:702-564-4838
Practice Address - Street 1:2525 W HORIZON RIDGE PKWY
Practice Address - Street 2:STE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5871
Practice Address - Country:US
Practice Address - Phone:702-564-6712
Practice Address - Fax:702-564-4838
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist