Provider Demographics
NPI:1780714568
Name:SPARKS, TODD A (MS, ATC, NASM-PES)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:SPARKS
Suffix:
Gender:M
Credentials:MS, ATC, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PAGE AVE
Mailing Address - Street 2:ORTHOPAEDIC REHAB SPECILISTS
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2418
Mailing Address - Country:US
Mailing Address - Phone:517-740-6079
Mailing Address - Fax:
Practice Address - Street 1:206 PAGE AVE
Practice Address - Street 2:ORTHOPAEDIC REHAB SPECILISTS
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2418
Practice Address - Country:US
Practice Address - Phone:517-740-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer