Spark Rehab Specialist LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

SPARK REHAB SPECIALIST LLC

Practice address

6025 Tapestry Dr
Corpus Christi, TX 78414-6334

Phone

(361) 389-4285

NPI assigned

Apr 22, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Brian Vergara Cornejo, PT,DPT

Title

Owner

Phone

(361) 389-4285

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555891200000",
    "number": "1831752252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6025 TAPESTRY DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784146334",
            "telephone_number": "361-389-4285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 TAPESTRY DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784146334",
            "telephone_number": "361-389-4285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK REHAB SPECIALIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-22",
        "last_updated": "2019-04-22",
        "status": "A",
        "authorized_official_last_name": "CORNEJO",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "VERGARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "361-389-4285",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT,DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Corpus Christi, TX
• Physical Therapy Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2019; 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.