Provider Demographics
| NPI: | 1033738687 |
|---|---|
| Name: | SPARKS PHYSICAL THERAPY, INC. |
| Entity type: | Organization |
| Organization Name: | SPARKS PHYSICAL THERAPY, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OFFICE MANAGER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | IRINA |
| Authorized Official - Middle Name: | MERCEDES |
| Authorized Official - Last Name: | FIGUEROA-VELEZ |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 443-212-5745 |
| Mailing Address - Street 1: | 954 RIDGEBROOK RD STE 310 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SPARKS GLENCOE |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21152-9440 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 443-212-5745 |
| Mailing Address - Fax: | 443-212-5749 |
| Practice Address - Street 1: | 954 RIDGEBROOK RD STE 310-330 |
| Practice Address - Street 2: | |
| Practice Address - City: | SPARKS GLENCOE |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21152-9468 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 443-212-5745 |
| Practice Address - Fax: | 443-212-5749 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-04-14 |
| Last Update Date: | 2024-11-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Multi-Specialty |
| No | 2251H1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Human Factors | Group - Multi-Specialty |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Multi-Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MD | 666629900 | Medicaid |
