Provider Demographics
NPI:1457015505
Name:PERFORM 2 WIN PHYSIOTHERAPY
Entity Type:Organization
Organization Name:PERFORM 2 WIN PHYSIOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-333-2943
Mailing Address - Street 1:5353 LEDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-5344
Mailing Address - Country:US
Mailing Address - Phone:323-333-2943
Mailing Address - Fax:
Practice Address - Street 1:601 CYPRESS AVE STE 402
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4645
Practice Address - Country:US
Practice Address - Phone:323-333-2943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy