MEDICARE: SPARKZ PHYSICAL THERAPY AND WELLNESS LLC

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
1	261QR0400X	Rehabilitation Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1205438249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARKZ PHYSICAL THERAPY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	5022 LOCKRIDGE SKY LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6804
Country	:	US
Telephone Number	:	763-742-3375
Fax Number	:

Provider Business Practice Location Address
First Line	:	5022 LOCKRIDGE SKY LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6804
Country	:	US
Telephone Number	:	763-742-3375
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AARATHI SRINIVASAN
Credential	:	DPT
Telephone Number	:	763-742-3375

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	11/13/2020

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