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General NPI Number Information
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NPI Number | 1942791744
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Entity Type | Organization
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Legal Business Name | ALTITUDE PHYSICAL THERAPY & FITNESS P.C.
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 27169 STATE HIGHWAY 189
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City | BLUE JAY
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State | CA
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Zip | 92317-0017
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Country | US
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Telephone | 909-754-4097
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Fax | 909-323-0215
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Provider Business Mailing Address
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Address Line | PO BOX 193
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City | BLUE JAY
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State | CA
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Zip | 92317-0193
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Country | US
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Telephone | 909-754-4097
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Fax | 909-323-0215
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. TARAH SPARKMAN
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Credential | PT, DPT
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Telephone | 909-754-4097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 39415
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License Number State | CA
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