Provider Demographics
NPI:1346552171
Name:SAPKO, JACKELYN DAWN
Entity Type:Individual
Prefix:
First Name:JACKELYN
Middle Name:DAWN
Last Name:SAPKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKELYN
Other - Middle Name:DAWN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3966 W GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8163
Mailing Address - Country:US
Mailing Address - Phone:417-838-5649
Mailing Address - Fax:
Practice Address - Street 1:1097 INDIAN GROVE LN
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-7669
Practice Address - Country:US
Practice Address - Phone:417-766-9819
Practice Address - Fax:417-753-7120
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005029638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist