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General NPI Number Information
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NPI Number | 1790115988
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Entity Type | Individual
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Provider Name | MS. SANDRA SPARKS
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Gender | Female
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 4008 PRESTON HWY
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City | LOUISVILLE
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State | KY
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Zip | 40213-1612
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Country | US
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Telephone | 502-368-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 736 RUNNING CREEK DR #5
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City | SHEPHERDSVILLE
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State | KY
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Zip | 40165-6964
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Country | US
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Telephone | 502-553-2508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 41602
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License Number State | KY
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