Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1377 | FL |
NPI | 1154432185 |
---|---|
Provider Name | Mr. Wade Duncan Sparks |
First Address | Columbia, SC 29229-7911 |
Second Address | Columbia, SC 29209-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |