Provider Demographics
NPI:1922725662
Name:ABILITIES PEDIATRIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ABILITIES PEDIATRIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFROTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:619-962-0316
Mailing Address - Street 1:9409 LAKE MURRAY BLVD UNIT E
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1467
Mailing Address - Country:US
Mailing Address - Phone:619-962-0316
Mailing Address - Fax:
Practice Address - Street 1:9409 LAKE MURRAY BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1467
Practice Address - Country:US
Practice Address - Phone:619-962-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency