Healthcare Provider Details

I. General information

NPI: 1245678176
Provider Name (Legal Business Name): SUCCESS PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2842 SEPULVEDA BLVD
TORRANCE CA
90505-2803
US

IV. Provider business mailing address

2842 SEPULVEDA BLVD
TORRANCE CA
90505-2803
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-0800
  • Fax: 310-325-7705
Mailing address:
  • Phone: 310-325-0800
  • Fax: 310-325-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT17060
License Number StateCA

VIII. Authorized Official

Name: NOELLE GILSON BUDROVICH
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 310-325-0800