Provider Demographics
NPI:1114355914
Name:SPEARS, STACI (CMT)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:SPEARS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5800 STANFORD RANCH RD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4385
Mailing Address - Country:US
Mailing Address - Phone:916-335-1287
Mailing Address - Fax:
Practice Address - Street 1:5800 STANFORD RANCH RD
Practice Address - Street 2:SUITE 610
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4385
Practice Address - Country:US
Practice Address - Phone:916-335-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist