Provider Demographics
NPI:1548621105
Name:SPENCER, ELIZABETH CARLYLE (L AC, LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CARLYLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:L AC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TANAGER LN NW
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-2534
Mailing Address - Country:US
Mailing Address - Phone:540-553-1374
Mailing Address - Fax:
Practice Address - Street 1:211 TANAGER LN NW
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2534
Practice Address - Country:US
Practice Address - Phone:540-553-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000805171100000X
VA0019008998225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist