Provider Demographics
NPI:1396278578
Name:ATHLETICA PHYSICAL THERAPY
Entity type:Organization
Organization Name:ATHLETICA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:562-598-5500
Mailing Address - Street 1:2112 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2530
Mailing Address - Country:US
Mailing Address - Phone:562-598-5500
Mailing Address - Fax:562-598-5550
Practice Address - Street 1:2112 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2530
Practice Address - Country:US
Practice Address - Phone:562-598-5500
Practice Address - Fax:562-598-5550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEAL BEACH PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty