Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305209458 | VA |
N | 2251X0800X | Physical Therapist - Orthopedic | 2305209458 | VA |
NPI | 1073960720 |
---|---|
Provider Name | Spencer Joseph Muro |
First Address | Newport News, VA 23601-3913 |
Second Address | Portsmouth, VA 23708-2197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2016 |
Last Update Date | 13/12/2021 |