| Organization Name: | SPARK45 FITNESS AND PHYSICAL THERAPY PC |
| NPI Number: | 1003281312 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIELLE BORDENAVE (OWNER/CEO) |
| Mailing Address: | 550 Maple St B Carpinteria |
| State: | CA US |
| Postal Code: | 930133559 |
| Phone Number: | 8052753000 |
| Fax Number: | |
| NPI Enumeration Date: | 12/11/2015 |
| NPI Last Update Date: | 02/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 42251 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |