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Individual
DR. SPENCER DAVID BLACKIE
Active
Individual
DR. SPENCER DAVID BLACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, MA, OTR,
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4300-24
WI
225X00000X
Occupational Therapist
1811-26
WI
Other
Enumeration date
12/12/2011
Last updated
12/12/2011
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