Provider Demographics
NPI:1982636635
Name:CHRISTINE L SPRYER
Entity Type:Organization
Organization Name:CHRISTINE L SPRYER
Other - Org Name:PACIFIC PHYSICAL THERAPY AND SPORTS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPRYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-798-6310
Mailing Address - Street 1:2615 PACIFIC COAST HWY STE 321
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2227
Mailing Address - Country:US
Mailing Address - Phone:310-798-6310
Mailing Address - Fax:310-798-6312
Practice Address - Street 1:2615 PACIFIC COAST HWY STE 321
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2227
Practice Address - Country:US
Practice Address - Phone:310-798-6310
Practice Address - Fax:310-798-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8740261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15426Medicare PIN