Provider Demographics
NPI:1467658815
Name:SPARKMAN, BRIAN S (LPTA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:SPARKMAN
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 ESPACE CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2230
Mailing Address - Country:US
Mailing Address - Phone:314-838-9738
Mailing Address - Fax:314-838-7044
Practice Address - Street 1:1425 N NEW FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2154
Practice Address - Country:US
Practice Address - Phone:314-838-3811
Practice Address - Fax:314-838-7044
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116394225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant