Organization
SPARK THERAPY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER NELSON (PHYSICAL THERAPIST)
(864) 270-4799
Entity
Organization
Contact information
Practice address
9 DREXEL AVE, GREENVILLE, SC 29615-1407
(864) 270-4799
Mailing address
2435 E NORTH ST STE 1108-176, GREENVILLE, SC 29615-1442
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
4054
SC
Other
Enumeration date
02/01/2017
Last updated
03/30/2017
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