Provider Demographics
NPI:1003448614
Name:SPORTS MEDICINE INSTITUTE INTERNATIONAL
Entity Type:Organization
Organization Name:SPORTS MEDICINE INSTITUTE INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FADIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-322-2809
Mailing Address - Street 1:260 SHERIDAN AVE STE B40
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2054
Mailing Address - Country:US
Mailing Address - Phone:650-322-2809
Mailing Address - Fax:650-325-6980
Practice Address - Street 1:260 SHERIDAN AVE STE B40
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2054
Practice Address - Country:US
Practice Address - Phone:650-322-2809
Practice Address - Fax:650-325-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty