Individual provider Active NPI

Brian S Sparkman, LPTA

  • Physical Therapy Assistant
  • Florissant, MO
National Provider Identifier
1467658815
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
116394 Issued in MO
Practice address
1425 N New Florissant Rd
Florissant, MO 63033-2154
Phone
(314) 838-3811
Fax
(314) 838-7044
NPI assigned
Jun 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 116394 MO Primary

Addresses

Primary practice location

1425 N New Florissant Rd
Florissant, MO 63033-2154

Mailing address

3500 Espace CT
Florissant, MO 63034-2230
Phone (314) 838-9738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
116394MOMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467658815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 ESPACE CT",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630342230",
            "telephone_number": "314-838-9738",
            "fax_number": "314-838-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N NEW FLORISSANT RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630332154",
            "telephone_number": "314-838-3811",
            "fax_number": "314-838-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKMAN",
        "first_name": "BRIAN",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "LPTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "116394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florissant, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.