Provider Demographics
NPI:1235776923
Name:PREHAB2PERFORM PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PREHAB2PERFORM PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUDELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:561-329-8500
Mailing Address - Street 1:830 HILL ST APT E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4674
Mailing Address - Country:US
Mailing Address - Phone:561-329-8500
Mailing Address - Fax:
Practice Address - Street 1:711 HAMPTON DR APT E
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3018
Practice Address - Country:US
Practice Address - Phone:561-329-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy