Provider Demographics
NPI:1760832257
Name:EZIA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EZIA PHYSICAL THERAPY LLC
Other - Org Name:NAKOA FITNESS AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILDEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-804-1700
Mailing Address - Street 1:6068 CORTE DEL CEDRO STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1514
Mailing Address - Country:US
Mailing Address - Phone:760-804-1700
Mailing Address - Fax:760-804-1780
Practice Address - Street 1:6068 CORTE DEL CEDRO STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1514
Practice Address - Country:US
Practice Address - Phone:760-804-1700
Practice Address - Fax:760-804-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherPHYSICAL THERAPY