Provider Demographics
NPI:1154477966
Name:SPEARS, TRACEY KIMBERLY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:KIMBERLY
Last Name:SPEARS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22627 STRAWBERRY CT
Mailing Address - Street 2:101
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4676
Mailing Address - Country:US
Mailing Address - Phone:313-433-7477
Mailing Address - Fax:
Practice Address - Street 1:26900 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5312
Practice Address - Country:US
Practice Address - Phone:248-350-8070
Practice Address - Fax:248-350-8078
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant