Healthcare Provider Details

I. General information

NPI: 1093267999
Provider Name (Legal Business Name): SONYA SPARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5714 BLUE STAR LN
SPOTSYLVANIA VA
22551-4707
US

IV. Provider business mailing address

5714 BLUE STAR LN
SPOTSYLVANIA VA
22551-4707
US

V. Phone/Fax

Practice location:
  • Phone: 540-755-9497
  • Fax:
Mailing address:
  • Phone: 540-755-9497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602280
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: