Provider Demographics
NPI:1669531737
Name:JOINT REHABILITATION & SPORTS MED CTR INC
Entity type:Organization
Organization Name:JOINT REHABILITATION & SPORTS MED CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-231-7000
Mailing Address - Street 1:11645 WILSHIRE BLVD #120
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-231-7000
Mailing Address - Fax:310-231-7227
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-231-7000
Practice Address - Fax:310-231-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16444111N00000X
CADC25828111N00000X
CAA54550204C00000X
CAPA18141363A00000X
CAPA15556363A00000X
CA611872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14696Medicare ID - Type Unspecified