Provider Demographics
NPI:1235921602
Name:CHURCHILL, SPENCER (PT)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:CHURCHILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0514
Mailing Address - Country:US
Mailing Address - Phone:701-258-7730
Mailing Address - Fax:701-258-7803
Practice Address - Street 1:2945 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0514
Practice Address - Country:US
Practice Address - Phone:701-258-7730
Practice Address - Fax:701-258-7803
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist