| NPI | 1144766064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD MICHAEL SPARKS Owner/ President 858-336-0163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 30298) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2021-03-23 |