# WATER AND SPORTS PHYSICAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588085625
- **Authorized official:** SOPHIA HAMILTON (OFFICE MANAGER)
- **Authorized official phone:** (858) 726-2624

## Contact information

- **Practice address:** 3639 MIDWAY DR, B286, SAN DIEGO, CA 92110-5254
- **Practice address phone:** (858) 488-3597
- **Practice address fax:** (858) 724-1747
- **Mailing address:** 3639 MIDWAY DR, B286, SAN DIEGO, CA 92110-5254
- **Mailing address phone:** (858) 488-3597
- **Mailing address fax:** (858) 724-1747

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | PT40754 | CA | Yes |

## Other

- **Enumeration date:** 12/16/2013
- **Last updated:** 12/16/2013