Healthcare Provider Details

I. General information

NPI: 1396205548
Provider Name (Legal Business Name): SPARC PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3878 W CARSON ST STE 101
TORRANCE CA
90503-6707
US

IV. Provider business mailing address

3878 W CARSON ST STE 101
TORRANCE CA
90503-6707
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-8878
  • Fax: 310-316-8879
Mailing address:
  • Phone: 310-316-8878
  • Fax: 310-316-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER KWON
Title or Position: CEO/PRESIDENT
Credential: PT, DPT
Phone: 818-792-0961