Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 2019030170 | MO |
NPI | 1063059780 |
---|---|
Provider Name | Dr. Adam Sparks |
First Address | Warrenton, MO 63383-1108 |
Second Address | Warrenton, MO 63383-1108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2019 |
Last Update Date | 01/12/2019 |