Provider Demographics
NPI:1649322702
Name:PACIFIC SPORTS PAIN ORTHOPEDIC REHABILITATION THERAPY SPECIALISTS
Entity type:Organization
Organization Name:PACIFIC SPORTS PAIN ORTHOPEDIC REHABILITATION THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSPEH
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-316-2368
Mailing Address - Street 1:PO BOX 13186
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-0186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21203 HAWTHORNE BLVD STE B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5520
Practice Address - Country:US
Practice Address - Phone:310-316-2368
Practice Address - Fax:310-316-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy