Provider Demographics
NPI:1447286067
Name:PHYSIOWORKS
Entity type:Organization
Organization Name:PHYSIOWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MAFFUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:310-374-0477
Mailing Address - Street 1:2621 MANHATTAN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1604
Mailing Address - Country:US
Mailing Address - Phone:310-374-0477
Mailing Address - Fax:310-374-1605
Practice Address - Street 1:2621 MANHATTAN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-1604
Practice Address - Country:US
Practice Address - Phone:310-374-0477
Practice Address - Fax:310-374-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19608Medicare ID - Type UnspecifiedGROUP ID