Provider Demographics
NPI:1265481139
Name:SPARKS, TODD (DPT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 E PALOMAR ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2493
Mailing Address - Country:US
Mailing Address - Phone:619-482-3000
Mailing Address - Fax:619-482-3001
Practice Address - Street 1:1392 E PALOMAR ST STE 503
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1895
Practice Address - Country:US
Practice Address - Phone:619-482-3000
Practice Address - Fax:858-452-3102
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT30298BMedicare PIN
CAWPT30298DMedicare PIN
CAWPT30298AMedicare PIN
CAAU326YMedicare PIN
CAWPT30298CMedicare PIN