Provider Demographics
NPI:1093755894
Name:PACIFIC SPORTS HEALTH MANAGEMENT, INC.
Entity Type:Organization
Organization Name:PACIFIC SPORTS HEALTH MANAGEMENT, INC.
Other - Org Name:SYNERGY PERFORMANCE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-333-1690
Mailing Address - Street 1:4111 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4161
Mailing Address - Country:US
Mailing Address - Phone:818-333-1690
Mailing Address - Fax:818-333-1697
Practice Address - Street 1:4111 W ALAMEDA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4161
Practice Address - Country:US
Practice Address - Phone:818-333-1690
Practice Address - Fax:818-333-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:2006-06-22
Deactivation Code:
Reactivation Date:2006-06-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty