Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT008014 | GA |
NPI | 1003025966 |
---|---|
Provider Name | Laura J Sparks |
First Address | Cumming, GA 30041-0200 |
Second Address | Cumming, GA 30040-2434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |