Provider Demographics
NPI:1063504421
Name:SPARROW, ROBERT A (MSPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:SPARROW
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD MILL RD APT 28
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1442
Mailing Address - Country:US
Mailing Address - Phone:516-647-7847
Mailing Address - Fax:
Practice Address - Street 1:7070 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-5902
Practice Address - Country:US
Practice Address - Phone:805-685-1755
Practice Address - Fax:805-685-1715
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT304102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT30410AMedicare ID - Type Unspecified