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General NPI Number Information
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NPI Number | 1235776923
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Entity Type | Organization
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Legal Business Name | PREHAB2PERFORM PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 711 HAMPTON DR APT E
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City | VENICE
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State | CA
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Zip | 90291-3018
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Country | US
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Telephone | 561-329-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 830 HILL ST APT E
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City | SANTA MONICA
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State | CA
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Zip | 90405-4674
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Country | US
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Telephone | 561-329-8500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN M SUDELL JR.
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Credential | PT, DPT
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Telephone | 561-329-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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