MEDICARE: SKYPARK PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ34487Z	OTHER	CA	PIN

General Provider Information

NPI Number	:	1346287687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYPARK PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	2811 WILSHIRE BLVD
Second Line	:	SUITE 690
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4803
Country	:	US
Telephone Number	:	310-828-7239
Fax Number	:	310-828-3306

Provider Business Practice Location Address
First Line	:	2811 WILSHIRE BLVD
Second Line	:	SUITE 690
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4803
Country	:	US
Telephone Number	:	310-828-7239
Fax Number	:	310-828-3306

Authorized Official
Title or Position	:	DIRECTOR, PATIENT ACCOUNTS
Name	:	MRS. SUE J FLEISCHAUER
Credential	:
Telephone Number	:	310-828-7239

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/21/2022

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Directions to “SKYPARK PHYSICAL THERAPY INC ” Practice Location

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