Healthcare Provider Details

I. General information

NPI: 1649322702
Provider Name (Legal Business Name): PACIFIC SPORTS PAIN ORTHOPEDIC REHABILITATION THERAPY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21203 HAWTHORNE BLVD STE B
TORRANCE CA
90503-5520
US

IV. Provider business mailing address

PO BOX 13186
TORRANCE CA
90503-0186
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-2368
  • Fax: 310-316-9388
Mailing address:
  • Phone:
  • 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: MR. JOSPEH T. CHAN
Title or Position: DIRECTOR
Credential: P.T.
Phone: 310-316-2368