Healthcare Provider Details

I. General information

NPI: 1851215271
Provider Name (Legal Business Name): JENNIFER LYNN SPARKS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 RODELL BARROW RD
LA GRANGE NC
28551-8562
US

IV. Provider business mailing address

750 RODELL BARROW RD
LA GRANGE NC
28551-8562
US

V. Phone/Fax

Practice location:
  • Phone: 919-734-1311
  • Fax: 919-734-8816
Mailing address:
  • Phone: 919-734-1311
  • Fax: 919-734-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25162
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: