NPIMap

Organization Active NPI

Water and Sports Physical Therapy, Inc

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1699840934
Registry record updated Aug 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT23900 Issued in CA
Legal business name
WATER AND SPORTS PHYSICAL THERAPY, INC
Practice address
2999 Mission Blvd
Suite 101
San Diego, CA 92109-8028
Phone
(858) 488-3597
Fax
(858) 488-3178
NPI assigned
Nov 21, 2006
Last updated
Aug 14, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
WATER AND SPORTS PHYSICAL THERAPY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sophia Hamilton
Title
Operations Manager
Phone
(858) 288-3597

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT27239 CA
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT23900 CA Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT20904 CA
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X CA

Addresses

Primary practice location

2999 Mission Blvd
Suite 101
San Diego, CA 92109-8028

Mailing address

3639 Midway Dr Ste B286
San Diego, CA 92110-5254
Phone (858) 488-3597

Other names 1

  • Mission Beach Water and Sports Physical Therapy, Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100519000835 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2365433232 Receives reassigned benefits from 39 practitioners
Practice locations: San Diego, CA; Poway, CA; Coronado, CA

National Provider Directory

National Provider Directory
Part of
Water and Sports Physical

Locations

4126 Executive Dr
La Jolla, CA 92037

12234 Poway Rd
Poway, CA 92064

10996 Torreyana Rd
San Diego, CA 92121

120 C Ave
Ste 110
San Diego, CA 92118
Phone (858) 225-7222

12395 El Camino Real
Ste 11
San Diego, CA 92130

12395 El Camino Real
Ste 111
San Diego, CA 92130
Phone (760) 879-4562

12625 High Bluff Dr
Ste 105
San Diego, CA 92130
Phone (858) 432-3030

3535 General Atomics Ct
San Diego, CA 92121
Phone (858) 724-0392

3639 Midway Dr
San Diego, CA 92110

3777 Townsgate Dr
San Diego, CA 92130

3974 Dove St
San Diego, CA 92103

501 W Broadway
San Diego, CA 92101
Phone (619) 237-9027

501 W Broadway
Ste F
San Diego, CA 92101

9875 Aviary Dr
San Diego, CA 92131

Practitioners & affiliated clinicians

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 61

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407974400000",
    "number": "1699840934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3639 MIDWAY DR STE B286",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921105254",
            "telephone_number": "858-488-3597",
            "fax_number": "858-488-3178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2999 MISSION BLVD",
            "address_2": "SUITE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921098028",
            "telephone_number": "858-488-3597",
            "fax_number": "858-488-3178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATER AND SPORTS PHYSICAL THERAPY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATER AND SPORTS PHYSICAL THERAPY, INC",
        "enumeration_date": "2006-11-21",
        "last_updated": "2014-08-14",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "SOPHIA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "858-288-3597"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT27239",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT23900",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT20904",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mission Beach Water and Sports Physical Therapy, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.