Healthcare Provider Details

I. General information

NPI: 1154002483
Provider Name (Legal Business Name): ENDURANCE PHYSICAL THERAPY A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 S RAYMOND AVE
PASADENA CA
91105-3249
US

IV. Provider business mailing address

4589 VIA MARISOL UNIT 353
LOS ANGELES CA
90042-5140
US

V. Phone/Fax

Practice location:
  • Phone: 626-639-2808
  • Fax: 626-489-4001
Mailing address:
  • Phone: 310-773-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ARI THEOGENE LANDIS BAQUET
Title or Position: OWNER & LEAD CLINICIAN
Credential: PT, DPT, OCS
Phone: 310-773-7202