Provider Demographics
NPI:1811691736
Name:SPEARS, ANNE GRACE TORISEVA (DPT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:GRACE TORISEVA
Last Name:SPEARS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:GRACE
Other - Last Name:TORISEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 W PALM ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3413
Mailing Address - Country:US
Mailing Address - Phone:218-203-8179
Mailing Address - Fax:
Practice Address - Street 1:1451 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-4049
Practice Address - Country:US
Practice Address - Phone:218-834-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist