Provider Demographics
NPI:1376783076
Name:MIZUTA & ASSOCIATES PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MIZUTA & ASSOCIATES PHYSICAL THERAPY, INC.
Other - Org Name:MIZUTA & ASSOCIATES PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:CRAFT
Authorized Official - Last Name:MIZUTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:619-599-8292
Mailing Address - Street 1:8281 POLIZZI PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3830
Mailing Address - Country:US
Mailing Address - Phone:804-475-6853
Mailing Address - Fax:
Practice Address - Street 1:2555 CAMINO DEL RIO S STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3704
Practice Address - Country:US
Practice Address - Phone:619-599-8292
Practice Address - Fax:619-599-8292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292282251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty