Provider Demographics
NPI:1346378494
Name:SPARE, THERESA ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:SPARE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:SASDELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:672 OLD SNOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOWELLTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37059
Mailing Address - Country:US
Mailing Address - Phone:615-597-9394
Mailing Address - Fax:
Practice Address - Street 1:825 FISHER AVE
Practice Address - Street 2:NHC SMITHVILLE
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166
Practice Address - Country:US
Practice Address - Phone:615-597-4284
Practice Address - Fax:615-597-0739
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3642225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant