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General NPI Number Information
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NPI Number | 1851849061
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Entity Type | Individual
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Provider Name | STEPHANIE MICHELLE SPARKS DPT
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Gender | Female
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 4524 INTELCO LOOP SE
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City | LACEY
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State | WA
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Zip | 98503-5941
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Country | US
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Telephone | 360-491-9890
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Fax |
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Provider Business Mailing Address
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Address Line | 4524 INTELCO LOOP SE
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City | LACEY
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State | WA
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Zip | 98503-5941
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Country | US
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Telephone | 360-491-9890
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60595256
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License Number State | WA
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