Provider Demographics
NPI:1649578170
Name:SPRENKLE, MIKE (RPT)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:SPRENKLE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:SPRENKLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:40345 DUTTON ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92223-4527
Mailing Address - Country:US
Mailing Address - Phone:951-845-7313
Mailing Address - Fax:
Practice Address - Street 1:40345 DUTTON STREET
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:951-845-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT6216OtherPHYSICAL THERAPIST