Healthcare Provider Details

I. General information

NPI: 1891812830
Provider Name (Legal Business Name): JOHN A SPARKMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 S NATIONAL AVE SUITE C5
SPRINGFIELD MO
65810-2773
US

IV. Provider business mailing address

15 APEX DR
HIGHLAND IL
62249-1282
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-9333
  • Fax: 417-881-9334
Mailing address:
  • Phone: 618-651-0444
  • Fax: 618-654-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number107428
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: