Healthcare Provider Details

I. General information

NPI: 1376783076
Provider Name (Legal Business Name): MIZUTA & ASSOCIATES PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8281 POLIZZI PL
SAN DIEGO CA
92123-3830
US

IV. Provider business mailing address

8281 POLIZZI PL
SAN DIEGO CA
92123-3830
US

V. Phone/Fax

Practice location:
  • Phone: 804-475-6853
  • Fax: 619-564-7121
Mailing address:
  • Phone: 804-475-6853
  • Fax: 619-564-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number29228
License Number StateCA

VIII. Authorized Official

Name: MARY KATHERINE MCLENDON
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-564-7120