Healthcare Provider Details

I. General information

NPI: 1770650277
Provider Name (Legal Business Name): FABRIZIO PHYSICAL THERAPY AND SPORTS MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10309 SANTA MONICA BLVD STE 200
LOS ANGELES CA
90025-5007
US

IV. Provider business mailing address

10309 SANTA MONICA BLVD STE 200
LOS ANGELES CA
90025-5007
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-5984
  • Fax: 310-553-5986
Mailing address:
  • Phone: 310-553-5984
  • Fax: 310-553-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number17758
License Number StateCA

VIII. Authorized Official

Name: DAVID MICHAEL FABRIZIO
Title or Position: OWNER/DIRECTOR
Credential: PT, OCS
Phone: 310-553-5984