Basic Information
| Provider Information | |||||||||
| NPI: | 1306182860 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPARROW | ||||||||
| FirstName: | KIRSTIN | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3320 WAKE FOREST RD STE 440 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198625040 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3320 WAKE FOREST RD STE 440 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193852600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2013 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305205392 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.