Healthcare Provider Details

I. General information

NPI: 1801025572
Provider Name (Legal Business Name): WATER PT SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 S SEPULVEDA BLVD
LOS ANGELES CA
90045-2940
US

IV. Provider business mailing address

PO BOX 1249
REDONDO BEACH CA
90278-0249
US

V. Phone/Fax

Practice location:
  • Phone: 310-991-7751
  • Fax: 310-881-1219
Mailing address:
  • Phone: 310-991-7751
  • Fax: 310-881-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25373
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT25373
License Number StateCA

VIII. Authorized Official

Name: JESSICA SEMMEL
Title or Position: OWNER
Credential:
Phone: 310-991-7751