Provider Demographics
NPI:1174913149
Name:SPENCER, SARA (ATC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 ROCKY MOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-8308
Mailing Address - Country:US
Mailing Address - Phone:828-729-1552
Mailing Address - Fax:
Practice Address - Street 1:365 COLLEGE RD RM 155
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23173-7364
Practice Address - Country:US
Practice Address - Phone:828-729-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0013422255A2300X
VA01260028982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer