Provider Demographics
NPI:1053137026
Name:RATKOVICH, SPENCER (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
Last Name:RATKOVICH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 W BEHREND DR APT 1091
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6907
Mailing Address - Country:US
Mailing Address - Phone:623-302-4462
Mailing Address - Fax:
Practice Address - Street 1:10100 W LAKE PLEASANT PKWY STE 1300
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2012
Practice Address - Country:US
Practice Address - Phone:623-334-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist