Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan Kizziar, DPT

Individual provider Physical Therapist · NPI 1851133862

Ethan Kizziar, DPT is a Physical Therapist in Private Practice in Coronado, California. Qualified in 2024, 2 years ago. Practices with Water and Sports Physical Therapy Inc, a 21-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2024
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

120 C Ave Ste 110
Coronado, CA 92118-1992
Phone: (858) 225-7222
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 306050 (CA)

Record details

NPI number1851133862
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedJune 10, 2024
Last updated in NPPESJuly 3, 2024
Certification dateJuly 3, 2024
Mailing address7845 Westside Dr Apt 427, San Diego, CA 92108-1261

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Water And Sports Physical Therapy Inc — 21 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Coronado