Provider Demographics
NPI:1356917090
Name:SPARGO, WESLEY SANTILLAN (PT)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:SANTILLAN
Last Name:SPARGO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 W 4250 S APT 402
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3231
Mailing Address - Country:US
Mailing Address - Phone:801-666-0415
Mailing Address - Fax:
Practice Address - Street 1:174 W 4250 S APT 402
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3231
Practice Address - Country:US
Practice Address - Phone:801-666-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12201338-24012251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports