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General NPI Number Information
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NPI Number | 1326504333
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Entity Type | Organization
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Legal Business Name | IATHLETE
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | 22715 HAWTHORNE BLVD STE B
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City | TORRANCE
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State | CA
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Zip | 90505-3613
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Country | US
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Telephone | 424-250-0365
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 LOMITA BLVD UNIT 5
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City | HARBOR CITY
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State | CA
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Zip | 90710-3806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NOOLEE KIM
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Credential | PT, DPT, OCS
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Telephone | 424-250-0365
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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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