Healthcare Provider Details

I. General information

NPI: 1750168795
Provider Name (Legal Business Name): VESSEL PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 1/2 N VERMONT AVE
LOS ANGELES CA
90027-1931
US

IV. Provider business mailing address

4100 HIGHLAND AVE UNIT A
MANHATTAN BEACH CA
90266-3030
US

V. Phone/Fax

Practice location:
  • Phone: 404-769-3525
  • Fax:
Mailing address:
  • Phone: 949-606-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY SCHULTZ
Title or Position: CEO
Credential: PT, DPT, SCS, CSCS
Phone: 949-606-3240