Ethan Kizziar, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

306050 Issued in CA

Practice address

120 C Ave Ste 110
Coronado, CA 92118-1992

Phone

(858) 225-7222

NPI assigned

Jun 10, 2024

Last updated

Jul 3, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Water and Sports Physical Therapy IncGroup PAC ID 2365433232, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Water and Sports Physical Therapy, Inc

  • Physical Therapist
  • San Diego, CA
  • NPI 1699840934
  Medicare reassignment Care Compare group NPD
• Water and Sports Physical Therapy

  • Physical Medicine & Rehabilitation Physician
  • San Diego, CA
  • NPI 1588085625
  NPD (past)

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1851133862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7845 WESTSIDE DR APT 427",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081261",
            "telephone_number": "503-575-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 C AVE STE 110",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921181992",
            "telephone_number": "858-225-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIZZIAR",
        "first_name": "ETHAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "306050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deann Dana Keating, NP
• Peter R. Kelly, M.D.
• Patricia Marie Kettlehake, MD
• Khan G Ha MD Inc
• Kinetic Inner Qi Acupuncture and Sports Medicine, Inc.
• Christopher Hampton Kleber, DDS
• Jessica Knebel, RN
• Arash Kohan, PHARMD
• John Elwood Kohler, OD
• Wael Kouli, MD

• Physical Therapist in Coronado, CA
• Providers in Coronado, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.