Provider Demographics
NPI:1922826239
Name:WALDEN, SPENCER THOMAS (LMT)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:THOMAS
Last Name:WALDEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N MAY UNIT 67
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7505
Mailing Address - Country:US
Mailing Address - Phone:260-273-1970
Mailing Address - Fax:
Practice Address - Street 1:602 N MAY UNIT 67
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7505
Practice Address - Country:US
Practice Address - Phone:260-273-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-30173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist