Individual
MARA M. SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.P.T.
Contact information
Practice address
14555 W NATIONAL AVE, STE. 135, NEW BERLIN, WI 53151-4494
(262) 827-3180
(262) 827-3180
Mailing address
851 S 70TH ST, STE. 101, WEST ALLIS, WI 53214-3147
(414) 777-5100
(414) 777-5112
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5696-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5696-024
STATE LICENSE
WI
Enumeration date
01/15/2007
Last updated
07/08/2007
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