Healthcare Provider Details

I. General information

NPI: 1033738687
Provider Name (Legal Business Name): SPARKS PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 RIDGEBROOK RD STE 310-330
SPARKS GLENCOE MD
21152-9468
US

IV. Provider business mailing address

954 RIDGEBROOK RD STE 310
SPARKS GLENCOE MD
21152-9440
US

V. Phone/Fax

Practice location:
  • Phone: 443-212-5745
  • Fax: 443-212-5749
Mailing address:
  • Phone: 443-212-5745
  • Fax: 443-212-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IRINA MERCEDES FIGUEROA-VELEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 443-212-5745