Provider Demographics
NPI:1568800860
Name:SPARKS, MELISSA R (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CAREFREE LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1712
Mailing Address - Country:US
Mailing Address - Phone:719-696-9685
Mailing Address - Fax:
Practice Address - Street 1:14 CAREFREE LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1712
Practice Address - Country:US
Practice Address - Phone:719-696-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant