Provider Demographics
NPI:1104433887
Name:SPARKES, KYLE (DPT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:SPARKES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10428 NW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3209
Mailing Address - Country:US
Mailing Address - Phone:405-519-5304
Mailing Address - Fax:
Practice Address - Street 1:11900 N MACARTHUR BLVD STE F7
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1801
Practice Address - Country:US
Practice Address - Phone:405-633-0783
Practice Address - Fax:405-896-8414
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200937650AMedicaid