Provider Demographics
NPI:1174611040
Name:SPITZER, DENNIS K (PT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:K
Last Name:SPITZER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1124
Mailing Address - Country:US
Mailing Address - Phone:559-322-5345
Mailing Address - Fax:559-322-5041
Practice Address - Street 1:615 4TH ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1124
Practice Address - Country:US
Practice Address - Phone:559-322-5345
Practice Address - Fax:559-322-5041
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA-PT17923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT179230OtherBLUE SHIELD
CA184456400OtherDEPT. OF LABOR
CAZZZ27924ZMedicare ID - Type UnspecifiedM/C GROUP ID
CAP33688Medicare UPIN
CA0PT179231Medicare ID - Type Unspecified