Provider Demographics
NPI:1255489332
Name:HYMANSON PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:HYMANSON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-477-8622
Mailing Address - Street 1:1217 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6017
Mailing Address - Country:US
Mailing Address - Phone:310-477-8622
Mailing Address - Fax:310-937-6926
Practice Address - Street 1:1217 9TH ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6017
Practice Address - Country:US
Practice Address - Phone:310-477-8622
Practice Address - Fax:310-937-6926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT75432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21332OtherMEDICARE PTAN
CAZZZ21430ZOtherBLUE SHIELD ID NUMBER