Provider Demographics
NPI:1841706520
Name:SPARKMAN, TARAH JEANETTE-GONZALEZ (DPT)
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:JEANETTE-GONZALEZ
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:JEANETTE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-0193
Mailing Address - Country:US
Mailing Address - Phone:909-754-4097
Mailing Address - Fax:
Practice Address - Street 1:27169 CA. HWY 189
Practice Address - Street 2:SUITE 2
Practice Address - City:BLUE JAY
Practice Address - State:CA
Practice Address - Zip Code:92317
Practice Address - Country:US
Practice Address - Phone:909-754-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist