Spark Physical Therapy & Sports Performance Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

SPARK PHYSICAL THERAPY & SPORTS PERFORMANCE INC

Practice address

8575 1/2 Knott Ave
Buena Park, CA 90620-3850

Phone

(714) 335-3182

NPI assigned

Jan 4, 2022

Organization subpart

No

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

Authorized official

Name

Ziad DahdulNPI 1467761395

Title

President

Phone

(714) 335-3182

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ziad Dahdul, DPT

  • Physical Therapist
  • Long Beach, CA
  • NPI 1467761395
  Medicare reassignment NPD Authorized official
• Aram Bebekyan

  • Sports Physical Therapist
  • Buena Park, CA
  • NPI 1962271544
  Medicare reassignment NPD

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1750042446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8575 1/2 KNOTT AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906203850",
            "telephone_number": "714-335-3182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8575 1/2 KNOTT AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906203850",
            "telephone_number": "714-335-3182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK PHYSICAL THERAPY & SPORTS PERFORMANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "DAHDUL",
        "authorized_official_first_name": "ZIAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-335-3182"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soon Y. Shim DDS, Inc
• Albert Soratorio
• South Gate Rose Phcy Inc
• Southgate Rose Pharmacy Inc
• Spencer N Spalding
• Karin Spruill I, P.T.
• St. Jude Hospital, Inc.
• St. Jude Neighborhood Health Centers
• St. Luke'S Home Health Services, Inc.
• Starbright Hospice, Inc.

• Physical Therapy Clinic/Center in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.