Provider Demographics
NPI:1932218567
Name:MIZUTA, ERICKA CRAFT (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:CRAFT
Last Name:MIZUTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8281 POLIZZI PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3830
Mailing Address - Country:US
Mailing Address - Phone:804-475-6853
Mailing Address - Fax:
Practice Address - Street 1:2555 CAMINO DEL RIO S STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3704
Practice Address - Country:US
Practice Address - Phone:619-599-8292
Practice Address - Fax:619-599-8292
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ16597Medicare UPIN