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General NPI Number Information
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NPI Number | 1336552009
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Entity Type | Organization
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Legal Business Name | JESSICA RISK PT INC
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 03/07/2015
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Provider Practice Location Address
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Address Line | 28990 PACIFIC COAST HWY BLDG A SUITE 205-C
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City | MALIBU
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State | CA
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Zip | 90265-3952
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Country | US
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Telephone | 818-599-6049
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Fax | 310-919-3600
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Provider Business Mailing Address
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Address Line | PO BOX 841
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City | MALIBU
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State | CA
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Zip | 90265-0841
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Country | US
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Telephone | 818-599-6049
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Fax | 310-919-3600
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Authorized Official
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Title or Position | OWNER/OFFICER/DIRECTOR
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Name | JESSICA RISK
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Credential | P.T., M.P.T.
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Telephone | 818-599-6049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 25951
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License Number State | CA
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