Healthcare Provider Details

I. General information

NPI: 1790141315
Provider Name (Legal Business Name): MARK SPEAR DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 THOUSAND OAKS BLVD
BERKELEY CA
94707-1541
US

IV. Provider business mailing address

1601 THOUSAND OAKS BLVD
BERKELEY CA
94707-1541
US

V. Phone/Fax

Practice location:
  • Phone: 510-289-5136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number42058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: