Healthcare Provider Details

I. General information

NPI: 1932468956
Provider Name (Legal Business Name): MAKING FIT FUN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W REDONDO BEACH BLVD STE. 201
GARDENA CA
90247-3227
US

IV. Provider business mailing address

1605 W REDONDO BEACH BLVD STE. 201
GARDENA CA
90247-3227
US

V. Phone/Fax

Practice location:
  • Phone: 310-748-8662
  • Fax:
Mailing address:
  • Phone: 310-748-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberPT7801
License Number StateCA

VIII. Authorized Official

Name: SONDRA K WYMAN
Title or Position: PHYSICAL THERAPY MANAGER
Credential:
Phone: 310-748-8662