Provider Demographics
NPI:1891812830
Name:SPARKMAN, JOHN A (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SPARKMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:15 APEX DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1282
Mailing Address - Country:US
Mailing Address - Phone:618-651-0444
Mailing Address - Fax:618-654-5439
Practice Address - Street 1:4730 S NATIONAL AVE
Practice Address - Street 2:SUITE C5
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2773
Practice Address - Country:US
Practice Address - Phone:417-881-9333
Practice Address - Fax:417-881-9334
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO107428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO146300001Medicare PIN