MEDICARE: JESSICA 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
1	225100000X	Physical Therapist	1185400	TX

General Provider Information

NPI Number	:	1285879585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SPARKS PT

Provider Business Mailing Address
First Line	:	8111 CYPRESSWOOD DR STE 102
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7180
Country	:	US
Telephone Number	:	281-376-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8111 CYPRESSWOOD DR STE 102
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7180
Country	:	US
Telephone Number	:	281-376-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	12/16/2008

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Directions to “ JESSICA SPARKS PT” Practice Location

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