Spencer Lewiston McIntosh, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT008218 Issued in PA

Practice address

800 E Lancaster Ave
Villanova, PA 19085-1603

Phone

(610) 519-4500

NPI assigned

Nov 23, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1558028639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 JONI CIR",
            "city": "DOUGLASSVILLE",
            "state": "PA",
            "postal_code": "195189359",
            "telephone_number": "610-780-7168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E LANCASTER AVE",
            "city": "VILLANOVA",
            "state": "PA",
            "postal_code": "190851603",
            "telephone_number": "610-519-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTOSH",
        "first_name": "SPENCER",
        "middle_name": "LEWISTON",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-23",
        "last_updated": "2023-07-28",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT008218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Main Line Endodontic Associates, P.C.
• Marquis Dental LLC
• Stewart William McCallum, M.D.
• John B. McDay, M.D.
• Mary McGonigle, D.O.
• Sarah McNabb, OTD, MED, OTR/L
• McShane Sports Medicine
• McShane Sports Medicine PC
• John M McShane, MD
• Medrite Medical Care PC

• Athletic Trainer in Villanova, PA
• Providers in Villanova, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.