Healthcare Provider Details

I. General information

NPI: 1689530644
Provider Name (Legal Business Name): SPARC PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 SIGNAL AVE NE STE D
ALBUQUERQUE NM
87113-1974
US

IV. Provider business mailing address

6101 SIGNAL AVE NE STE D
ALBUQUERQUE NM
87113-1974
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-5124
  • Fax:
Mailing address:
  • Phone: 505-585-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATIE WEEMS
Title or Position: OWNER
Credential: MPT
Phone: 505-585-5124