Provider Demographics
NPI:1639190465
Name:SPARN, THERESE ELIZABETH (MA, ATC)
Entity Type:Individual
Prefix:MS
First Name:THERESE
Middle Name:ELIZABETH
Last Name:SPARN
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2190 MEMORIAL DR APT A23
Mailing Address - Street 2:PO BOX 3574
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4790
Mailing Address - Country:US
Mailing Address - Phone:931-645-1961
Mailing Address - Fax:931-645-1961
Practice Address - Street 1:151 RICHVIEW RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4723
Practice Address - Country:US
Practice Address - Phone:931-645-1961
Practice Address - Fax:931-645-1961
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer