Healthcare Provider Details

I. General information

NPI: 1497610505
Provider Name (Legal Business Name): CLINTON HARWICK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20902 SKIMMER LN
HUNTINGTON BEACH CA
92646-6551
US

IV. Provider business mailing address

20902 SKIMMER LN
HUNTINGTON BEACH CA
92646-6551
US

V. Phone/Fax

Practice location:
  • Phone: 626-863-3378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: