Provider Demographics
NPI:1114216975
Name:NAKOA FITNESS AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:NAKOA FITNESS AND PHYSICAL THERAPY LLC
Other - Org Name:EZIA PHYSICAL THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:CHICO
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-804-1700
Mailing Address - Street 1:6068 CORTE DEL CEDRO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1514
Mailing Address - Country:US
Mailing Address - Phone:760-804-1700
Mailing Address - Fax:760-807-1780
Practice Address - Street 1:6068 CORTE DEL CEDRO
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1514
Practice Address - Country:US
Practice Address - Phone:760-804-1700
Practice Address - Fax:760-807-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherPHYSICAL THERAPY