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General NPI Number Information
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NPI Number | 1699840934
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Entity Type | Organization
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Legal Business Name | WATER AND SPORTS PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 2999 MISSION BLVD SUITE 101
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City | SAN DIEGO
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State | CA
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Zip | 92109-8028
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Country | US
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Telephone | 858-488-3597
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Fax | 858-488-3178
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Provider Business Mailing Address
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Address Line | 3639 MIDWAY DR STE B286
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City | SAN DIEGO
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State | CA
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Zip | 92110-5254
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Country | US
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Telephone | 858-488-3597
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Fax | 858-488-3178
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | SOPHIA HAMILTON
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Credential |
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Telephone | 858-288-3597
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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 | PT27239
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT20904
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT23900
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License Number State | CA
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