Healthcare Provider Details

I. General information

NPI: 1922386762
Provider Name (Legal Business Name): CLUB SPORTIF AND SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 S ARROYO PKWY
PASADENA CA
91105-3232
US

IV. Provider business mailing address

780 S ARROYO PKWY
PASADENA CA
91105-3232
US

V. Phone/Fax

Practice location:
  • Phone: 626-844-6458
  • Fax:
Mailing address:
  • Phone: 626-844-6458
  • 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: MRS. SYLVIANE SYLVIE CHAPOULAUD
Title or Position: OWNER
Credential:
Phone: 626-844-6458