Provider Demographics
NPI:1235238890
Name:TOTAL FITNESS SPORTS THERAPY
Entity Type:Organization
Organization Name:TOTAL FITNESS SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARAN
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:SJODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-470-0442
Mailing Address - Street 1:2180 WESTWOOD BLVD., # 1D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-470-0442
Mailing Address - Fax:310-470-0112
Practice Address - Street 1:2180 WESTWOOD BLVD., # 1D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-470-0442
Practice Address - Fax:310-470-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicare ID - Type UnspecifiedPHYSICAL THERAPY