Provider Demographics
NPI:1952346512
Name:AKINS ALDOUS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AKINS ALDOUS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:AKINS
Authorized Official - Last Name:ALDOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS
Authorized Official - Phone:310-433-9255
Mailing Address - Street 1:4075 AVENIDA SEVILLA
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3411
Mailing Address - Country:US
Mailing Address - Phone:310-433-9255
Mailing Address - Fax:714-527-2378
Practice Address - Street 1:900 WILSHIRE BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1872
Practice Address - Country:US
Practice Address - Phone:310-433-9255
Practice Address - Fax:714-527-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT240410OtherBLUE SHIELD OF CA PRVDR #