Healthcare Provider Details

I. General information

NPI: 1205438249
Provider Name (Legal Business Name): SPARKZ PHYSICAL THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5022 LOCKRIDGE SKY LN
SUGAR LAND TX
77479-6804
US

IV. Provider business mailing address

5022 LOCKRIDGE SKY LN
SUGAR LAND TX
77479-6804
US

V. Phone/Fax

Practice location:
  • Phone: 763-742-3375
  • Fax:
Mailing address:
  • Phone: 763-742-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AARATHI SRINIVASAN
Title or Position: OWNER
Credential: DPT
Phone: 763-742-3375