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General NPI Number Information
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NPI Number | 1578592424
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Entity Type | Organization
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Legal Business Name | REDONDO ORTHOPEDIC PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 06/10/2023
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Provider Practice Location Address
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Address Line | 23133 HAWTHORNE BLVD STE 104
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City | TORRANCE
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State | CA
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Zip | 90505-3729
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Country | US
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Telephone | 310-321-4056
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Fax |
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Provider Business Mailing Address
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Address Line | 520 N PROSPECT AVE STE 100
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3033
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Country | US
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Telephone | 310-376-9222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVE P TYSSEE
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Credential | DPT, ATC
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Telephone | 310-376-9222
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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 | PT23254
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License Number State | CA
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