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General NPI Number Information
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NPI Number | 1659039535
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Entity Type | Organization
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Legal Business Name | SPARK PHYSICAL THERAPY AND PERFORMANCE, LLC
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 12/04/2022
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Provider Practice Location Address
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Address Line | 7810 MIDDLE POYNER DR STE 101
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City | RALEIGH
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State | NC
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Zip | 27616-2898
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Country | US
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Telephone | 614-352-3343
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 HERITAGE VIEW TRL
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City | WAKE FOREST
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State | NC
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Zip | 27587-3919
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | BRIAN SCHIFF
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Credential | PT, DPT
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Telephone | 614-352-3343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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