Provider Demographics
NPI:1558615492
Name:SPORTSFIT PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:SPORTSFIT PHYSICAL THERAPY CORPORATION
Other - Org Name:SPORTSFIT PHYSICAL THERAPY AND FITNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOURAK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-878-2540
Mailing Address - Street 1:2010 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5608
Mailing Address - Country:US
Mailing Address - Phone:310-878-2540
Mailing Address - Fax:310-878-2536
Practice Address - Street 1:2010 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5608
Practice Address - Country:US
Practice Address - Phone:310-878-2540
Practice Address - Fax:310-878-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT344462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty