Provider Demographics
NPI:1487906178
Name:SPEARS, LISA J (LMT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:SPEARS
Suffix:
Gender:F
Credentials:LMT
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Mailing Address - Street 1:44 HUGHES RD
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3045
Mailing Address - Country:US
Mailing Address - Phone:256-325-5400
Mailing Address - Fax:256-325-5469
Practice Address - Street 1:44 HUGHES RD
Practice Address - Street 2:SUITE 1050
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3045
Practice Address - Country:US
Practice Address - Phone:256-325-5400
Practice Address - Fax:256-325-5469
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALLMT2046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALLMT2046OtherSTATE LICENSE