Provider Demographics
NPI:1508140005
Name:SPEARS, JANICE A (PTA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:SPEARS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 W EMELITA AVE
Mailing Address - Street 2:#1144
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4035
Mailing Address - Country:US
Mailing Address - Phone:562-484-4600
Mailing Address - Fax:
Practice Address - Street 1:1840 W EMELITA AVE
Practice Address - Street 2:#1144
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4035
Practice Address - Country:US
Practice Address - Phone:562-484-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 2600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist