Provider Demographics
NPI:1558517631
Name:SPARLING, LISA JO DENT (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA JO
Middle Name:DENT
Last Name:SPARLING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3572 SUMMERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4267
Mailing Address - Country:US
Mailing Address - Phone:336-922-4843
Mailing Address - Fax:
Practice Address - Street 1:2206 RIDGE CREST LN
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2483
Practice Address - Country:US
Practice Address - Phone:336-786-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist