MEDICARE: SPARK WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1356297717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARK WELLNESS LLC

Provider Business Mailing Address
First Line	:	1407 AYLESBURY DR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-8214
Country	:	US
Telephone Number	:	706-250-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	4007 COLUMBIA RD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-2221
Country	:	US
Telephone Number	:	706-250-1151
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MS. KIMBERLY M TAYLOR
Credential	:	PT
Telephone Number	:	706-250-1151

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/23/2026

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Directions to “SPARK WELLNESS LLC ” Practice Location

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