Provider Demographics
NPI:1871544700
Name:ULRICH, SPENCER (PT)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:
Last Name:ULRICH
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 1:74 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1619
Mailing Address - Country:US
Mailing Address - Phone:908-464-6496
Mailing Address - Fax:
Practice Address - Street 1:68 RIVER RD
Practice Address - Street 2:C/O EQUINOX
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-1450
Practice Address - Country:US
Practice Address - Phone:908-277-0800
Practice Address - Fax:908-277-0808
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025473225100000X
NJ40QA01437800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ32U61Medicare PIN