Provider Demographics
NPI:1356667828
Name:ATTIKEN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ATTIKEN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:949-375-6761
Mailing Address - Street 1:715 AVOCADO AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1938
Mailing Address - Country:US
Mailing Address - Phone:949-375-6761
Mailing Address - Fax:
Practice Address - Street 1:715 AVOCADO AVE
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1938
Practice Address - Country:US
Practice Address - Phone:949-375-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24596261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT24596AMedicare PIN