Healthcare Provider Details

I. General information

NPI: 1356439996
Provider Name (Legal Business Name): THE SPORTSMED COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 S SEPULVEDA BLVD
LOS ANGELES CA
90025-4313
US

IV. Provider business mailing address

1835 S SEPULVEDA BLVD
LOS ANGELES CA
90025-4313
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-6222
  • Fax: 310-478-6696
Mailing address:
  • Phone: 310-478-6222
  • Fax: 310-478-6696

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: MR. BRIAN JOSEPH HOHL
Title or Position: PRESIDENT
Credential: MPT
Phone: 310-478-6222