| Doctor Name: | MR. SPENCER ANDREW WINGATE |
| NPI Number: | 1205988789 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT003181 |
| Business Practice Address: | 921 Moores Ferry Rd Suite D Villa Rica, GA - 301809703 |
| Business Phone Number: | 6788408881 |
| Business Fax Number: | 6788408885 |
| Mailing Address: | 8823 Production Ln, OOLTEWAH |
| State: | TN |
| Postal Code: | 373636511 |
| Phone Number: | 4232387217 |
| Fax Number: | 4239547408 |
| NPI Enumeration Date: | 01/17/2007 |
| NPI Last Update Date: | 04/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | PT003181 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |