Provider Demographics
NPI:1982655882
Name:SPEARS, ERIC SHANE (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SHANE
Last Name:SPEARS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SAGEBRUSH LN STE 1
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-2320
Mailing Address - Country:US
Mailing Address - Phone:406-846-7770
Mailing Address - Fax:406-846-7771
Practice Address - Street 1:825 SAGEBRUSH LN STE 1
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-2320
Practice Address - Country:US
Practice Address - Phone:406-846-7990
Practice Address - Fax:406-846-7771
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1529PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401554Medicaid
MT060833OtherBC BS
MT000050819Medicare PIN