Provider Demographics
NPI:1437946076
Name:GREGORY, SPENCER DEE
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:DEE
Last Name:GREGORY
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 1:1717 SCOTTSDALE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4770
Mailing Address - Country:US
Mailing Address - Phone:512-962-9141
Mailing Address - Fax:
Practice Address - Street 1:1717 SCOTTSDALE DR STE 220
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78641-4770
Practice Address - Country:US
Practice Address - Phone:512-962-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14067192251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports