Provider Demographics
NPI:1063600658
Name:A PHYSICAL THERAPY ALTERNATIVE
Entity type:Organization
Organization Name:A PHYSICAL THERAPY ALTERNATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-828-6584
Mailing Address - Street 1:1450 CLOVERFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2943
Mailing Address - Country:US
Mailing Address - Phone:310-828-6584
Mailing Address - Fax:310-453-3373
Practice Address - Street 1:1450 CLOVERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2943
Practice Address - Country:US
Practice Address - Phone:310-828-6584
Practice Address - Fax:310-453-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18871Medicare PIN