Provider Demographics
NPI:1003892183
Name:SPARKS, SUSAN M (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-1640
Mailing Address - Country:US
Mailing Address - Phone:423-243-0084
Mailing Address - Fax:413-243-0861
Practice Address - Street 1:740 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7463
Practice Address - Country:US
Practice Address - Phone:413-447-8070
Practice Address - Fax:413-445-4918
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA01782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10078447OtherCDPHP
MA0349674Medicaid
MA10048048OtherRAILROAD MEDICARE
MASPY65360OtherBCBS OF MASSACHUSETTS
MA435807OtherMVP
MA435807OtherMVP