Provider Demographics
NPI:1114316072
Name:SKYPARK PHYSICAL THERAPY & REHABILITATION
Entity Type:Organization
Organization Name:SKYPARK PHYSICAL THERAPY & REHABILITATION
Other - Org Name:SKYPARK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KIYOSHI
Authorized Official - Last Name:KOYANAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:310-999-5562
Mailing Address - Street 1:23332 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3749
Mailing Address - Country:US
Mailing Address - Phone:310-373-5288
Mailing Address - Fax:310-373-6223
Practice Address - Street 1:23332 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3749
Practice Address - Country:US
Practice Address - Phone:310-373-5288
Practice Address - Fax:310-373-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37640261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy