Provider Demographics
NPI:1740656206
Name:SPARKS, JONATHAN PATRICK (DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PATRICK
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 10TH AVE E
Mailing Address - Street 2:APT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4207
Mailing Address - Country:US
Mailing Address - Phone:425-372-6100
Mailing Address - Fax:
Practice Address - Street 1:200 ANDOVER PARK E
Practice Address - Street 2:# 8
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2938
Practice Address - Country:US
Practice Address - Phone:206-575-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60565742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist