Provider Demographics
NPI:1598711566
Name:PLAYA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PLAYA PHYSICAL THERAPY
Other - Org Name:PLAYA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-823-2220
Mailing Address - Street 1:13163 FOUNTAIN PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2040
Mailing Address - Country:US
Mailing Address - Phone:310-823-2220
Mailing Address - Fax:310-823-2636
Practice Address - Street 1:13163 FOUNTAIN PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2040
Practice Address - Country:US
Practice Address - Phone:310-823-2220
Practice Address - Fax:310-823-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08931ZOtherBLUE SHIELD PROVIDER #
CAZZZ08931ZOtherBLUE SHIELD PROVIDER #