Healthcare Provider Details

I. General information

NPI: 1669531737
Provider Name (Legal Business Name): JOINT REHABILITATION & SPORTS MED CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD SUITE 120
LOS ANGELES CA
90025-1708
US

IV. Provider business mailing address

11645 WILSHIRE BLVD #120
LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-231-7000
  • Fax: 310-231-7227
Mailing address:
  • Phone: 310-231-7000
  • Fax: 310-231-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18141
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15556
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number611872
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16444
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25828
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA54550
License Number StateCA

VIII. Authorized Official

Name: CHRISTY KESSLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-231-7000