Provider Demographics
NPI:1649001710
Name:SPARKS, HUNTER (PT, DPT)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N A W GRIMES BLVD APT 6308
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2758
Mailing Address - Country:US
Mailing Address - Phone:832-818-6433
Mailing Address - Fax:
Practice Address - Street 1:567 CHRIS KELLEY BLVD
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-2085
Practice Address - Country:US
Practice Address - Phone:567-846-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1395675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist