Healthcare Provider Details

I. General information

NPI: 1417781220
Provider Name (Legal Business Name): VIDA KIDS PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11726 SAN VICENTE BLVD STE 222
LOS ANGELES CA
90049-5045
US

IV. Provider business mailing address

11726 SAN VICENTE BLVD STE 222
LOS ANGELES CA
90049-5045
US

V. Phone/Fax

Practice location:
  • Phone: 424-724-0944
  • Fax:
Mailing address:
  • Phone: 424-724-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA HUGHELL
Title or Position: CEO/PHYSICAL THERAPIST
Credential: PT
Phone: 424-422-0446