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General NPI Number Information
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NPI Number | 1528259249
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Entity Type | Organization
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Legal Business Name | SLOWMOTION FITNESS LLC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 1872 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-4314
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Country | US
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Telephone | 310-481-9959
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Fax |
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Provider Business Mailing Address
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Address Line | 1872 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-4314
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Country | US
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Telephone | 310-481-9959
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG DEANS
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Credential |
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Telephone | 310-481-9959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT29766
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License Number State | CA
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