Provider Demographics
NPI:1073881348
Name:SPARKS, BRYAN T (BS, CP, LP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:T
Last Name:SPARKS
Suffix:
Gender:M
Credentials:BS, CP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8239 ALMEDA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4101
Mailing Address - Country:US
Mailing Address - Phone:713-748-0250
Mailing Address - Fax:713-748-0840
Practice Address - Street 1:8239 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4101
Practice Address - Country:US
Practice Address - Phone:713-748-0250
Practice Address - Fax:713-748-0840
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1522224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist