Provider Demographics
NPI:1083776009
Name:EXOS - ATHLETES' PERFORMANCE LOS ANGELES LLC
Entity Type:Organization
Organization Name:EXOS - ATHLETES' PERFORMANCE LOS ANGELES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-618-3246
Mailing Address - Street 1:18400 AVALON BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2172
Mailing Address - Country:US
Mailing Address - Phone:310-630-2290
Mailing Address - Fax:310-630-2292
Practice Address - Street 1:18400 AVALON BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2172
Practice Address - Country:US
Practice Address - Phone:310-630-2290
Practice Address - Fax:310-630-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty