Provider Demographics
NPI:1255660221
Name:VERT CENTER OF SANTA MONICA
Entity Type:Organization
Organization Name:VERT CENTER OF SANTA MONICA
Other - Org Name:VERT SPORT THERAPY AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:THEIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:310-264-8385
Mailing Address - Street 1:3011 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2301
Mailing Address - Country:US
Mailing Address - Phone:310-264-8385
Mailing Address - Fax:310-264-9076
Practice Address - Street 1:3011 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2301
Practice Address - Country:US
Practice Address - Phone:310-264-8385
Practice Address - Fax:310-264-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17118Medicare UPIN