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NPI Code Detail

MEDICARE: MS. SUSAN M SPARKS PT

MEDICARE: MS. SUSAN M SPARKS PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist01782MA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
310048048OTHERMARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110078447OTHERMACDPHP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4SPY65360OTHERMABCBS OF MASSACHUSETTS
5435807OTHERMAMVP

General Provider Information

NPI Number : 1003892183
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN M SPARKS PT
Provider Business Mailing Address
First Line : 107 FRANKLIN ST
Second Line :
City : LEE
State : MA
Zip : 01238-1640
Country : US
Telephone Number : 423-243-0084
Fax Number : 413-243-0861
Provider Business Practice Location Address
First Line : 740 WILLIAMS ST
Second Line :
City : PITTSFIELD
State : MA
Zip : 01201-7463
Country : US
Telephone Number : 413-447-8070
Fax Number : 413-445-4918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 07/08/2007

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Directions to “ MS. SUSAN M SPARKS PT” Practice Location

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