Provider Demographics
NPI:1760500573
Name:SPARROW, ANNA (PTA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SPARROW
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 1:10097 MARVIL DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-3939
Mailing Address - Country:US
Mailing Address - Phone:302-854-6575
Mailing Address - Fax:302-854-6580
Practice Address - Street 1:110 W NORTH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2137
Practice Address - Country:US
Practice Address - Phone:302-854-6575
Practice Address - Fax:302-854-6580
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2000476225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant