Provider Demographics
NPI:1518195759
Name:SPLASH PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SPLASH PHYSICAL THERAPY INC
Other - Org Name:WATER PHYSICAL THERAPY SPECIALISTS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:310-407-5440
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-0728
Mailing Address - Country:US
Mailing Address - Phone:310-407-5440
Mailing Address - Fax:310-407-5441
Practice Address - Street 1:8015 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-2940
Practice Address - Country:US
Practice Address - Phone:310-407-5440
Practice Address - Fax:310-407-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25373225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT25373OtherCALIFORNIA LICENCE