=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861371585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPARKS PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2025
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 20TH AVE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98122-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-651-5086
-----------------------------------------------------
Fax | 206-690-4402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1121 17TH AVE APT 201
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98122-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-651-5086
-----------------------------------------------------
Fax | 206-690-4402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | JONATHAN PATRICK SPARKS
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 425-372-6100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------