Provider Demographics
NPI:1942791744
Name:ALTITUDE PHYSICAL THERAPY & FITNESS P.C.
Entity type:Organization
Organization Name:ALTITUDE PHYSICAL THERAPY & FITNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:909-754-4097
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:909-323-0215
Practice Address - Street 1:27169 STATE HIGHWAY 189
Practice Address - Street 2:
Practice Address - City:BLUE JAY
Practice Address - State:CA
Practice Address - Zip Code:92317-0017
Practice Address - Country:US
Practice Address - Phone:909-754-4097
Practice Address - Fax:909-323-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39415261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy