MEDICARE: MR. TODD SPARKS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT30298	CA

General Provider Information

NPI Number	:	1265481139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD SPARKS DPT

Provider Business Mailing Address
First Line	:	1392 E PALOMAR ST
Second Line	:	SUITE 503
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-2493
Country	:	US
Telephone Number	:	619-482-3000
Fax Number	:	619-482-3001

Provider Business Practice Location Address
First Line	:	1392 E PALOMAR ST STE 503
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-1895
Country	:	US
Telephone Number	:	619-482-3000
Fax Number	:	858-452-3102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	04/08/2024

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