Provider Demographics
NPI:1851794911
Name:MIZUMOTO, AIMI YURIKA (DPT)
Entity Type:Individual
Prefix:
First Name:AIMI
Middle Name:YURIKA
Last Name:MIZUMOTO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18425 BURBANK BLVD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2806
Mailing Address - Country:US
Mailing Address - Phone:818-996-8386
Mailing Address - Fax:818-996-8979
Practice Address - Street 1:18425 BURBANK BLVD
Practice Address - Street 2:SUITE 413
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2806
Practice Address - Country:US
Practice Address - Phone:818-996-8386
Practice Address - Fax:818-996-8979
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist