Provider Demographics
NPI:1831488527
Name:STUDIO BRAVA PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:STUDIO BRAVA PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:CLAUDIA
Authorized Official - Last Name:POPESCU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-775-1609
Mailing Address - Street 1:11110 OHIO AVE
Mailing Address - Street 2:# 105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3388
Mailing Address - Country:US
Mailing Address - Phone:310-775-1609
Mailing Address - Fax:310-935-4555
Practice Address - Street 1:11110 OHIO AVE
Practice Address - Street 2:# 105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3388
Practice Address - Country:US
Practice Address - Phone:310-775-1609
Practice Address - Fax:310-935-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33305261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy