Provider Demographics
NPI:1760638134
Name:SPEAR, DEANNE ACETO (PT)
Entity Type:Individual
Prefix:MS
First Name:DEANNE
Middle Name:ACETO
Last Name:SPEAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8288 LAKE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:SODUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14555-9614
Mailing Address - Country:US
Mailing Address - Phone:315-945-4482
Mailing Address - Fax:
Practice Address - Street 1:8288 LAKE STREET EXT
Practice Address - Street 2:
Practice Address - City:SODUS POINT
Practice Address - State:NY
Practice Address - Zip Code:14555-9614
Practice Address - Country:US
Practice Address - Phone:315-945-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist