Provider Demographics
NPI:1336552009
Name:JESSICA RISK PT INC
Entity Type:Organization
Organization Name:JESSICA RISK PT INC
Other - Org Name:RESTORATION PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RISK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:818-599-6049
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-0841
Mailing Address - Country:US
Mailing Address - Phone:818-599-6049
Mailing Address - Fax:310-919-3600
Practice Address - Street 1:28990 PACIFIC COAST HWY BLDG A
Practice Address - Street 2:SUITE 205-C
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3952
Practice Address - Country:US
Practice Address - Phone:818-599-6049
Practice Address - Fax:310-919-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty