Provider Demographics
NPI:1669727525
Name:MARCIAL, AMITY SPARKS (DPT)
Entity type:Individual
Prefix:MISS
First Name:AMITY
Middle Name:SPARKS
Last Name:MARCIAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7858
Mailing Address - Country:US
Mailing Address - Phone:406-862-9378
Mailing Address - Fax:406-862-9882
Practice Address - Street 1:4733 KIBLER RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-8406
Practice Address - Country:US
Practice Address - Phone:479-268-2949
Practice Address - Fax:855-889-4129
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-4357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty