Healthcare Provider Details

I. General information

NPI: 1023353448
Provider Name (Legal Business Name): AYAKO PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AVOCADO AVE # 808
NEWPORT BEACH CA
92660-7720
US

IV. Provider business mailing address

1401 AVOCADO AVE # 808
NEWPORT BEACH CA
92660-7720
US

V. Phone/Fax

Practice location:
  • Phone: 949-706-1001
  • Fax: 949-706-1002
Mailing address:
  • Phone: 949-706-1001
  • Fax: 949-706-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT14876
License Number StateNULL

VIII. Authorized Official

Name: AYAKO NIVA SHONO
Title or Position: OWNER
Credential:
Phone: 949-706-1001