Healthcare Provider Details

I. General information

NPI: 1518195759
Provider Name (Legal Business Name): SPLASH PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 S SEPULVEDA BLVD
WESTCHESTER CA
90045-2940
US

IV. Provider business mailing address

PO BOX 728
TOPANGA CA
90290-0728
US

V. Phone/Fax

Practice location:
  • Phone: 310-407-5440
  • Fax: 310-407-5441
Mailing address:
  • Phone: 310-407-5440
  • Fax: 310-407-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NANCY LYNN HAWKINS
Title or Position: OWNER
Credential: MPT
Phone: 310-407-5440