Individual
SPENCER MCNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4637 ROUND LAKE RD APT G, INDIANAPOLIS, IN 46205-2334
(812) 325-0353
Mailing address
4637 ROUND LAKE RD APT G, INDIANAPOLIS, IN 46205-2334
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT22107325
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
11/14/2021
Last updated
11/14/2021
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