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General NPI Number Information
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NPI Number | 1255349676
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Entity Type | Organization
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Legal Business Name | HARBOR PHYSICAL THERAPY & SPORTS MEDICAL
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 1294 WEST 6TH STREET SUITE 101
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City | SAN PEDRO
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State | CA
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Zip | 90732-2997
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Country | US
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Telephone | 310-547-1850
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Fax | 310-547-1972
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Provider Business Mailing Address
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Address Line | 1294 WEST 6TH STREET SUITE 101
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City | SAN PEDRO
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State | CA
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Zip | 90732-2997
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Country | US
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Telephone | 310-547-1850
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Fax | 310-547-1972
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. MICHAEL T ODONNELL
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Credential | DPT, OCS
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Telephone | 310-547-1850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT11977
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License Number State | CA
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