Healthcare Provider Details

I. General information

NPI: 1740304708
Provider Name (Legal Business Name): AIM SPORTS MEDICINE AND PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 AVIATION BLVD
HERMOSA BEACH CA
90254-4023
US

IV. Provider business mailing address

1035 AVIATION BLVD
HERMOSA BEACH CA
90254-4023
US

V. Phone/Fax

Practice location:
  • Phone: 310-937-2323
  • Fax:
Mailing address:
  • Phone: 310-937-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARINA M ESCUDERO
Title or Position: OWNER
Credential: DPT
Phone: 310-937-2323