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General NPI Number Information
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NPI Number | 1801929369
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Entity Type | Organization
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Legal Business Name | RIVIERA SPORTS PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 1204 S PACIFIC COAST HWY
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City | REDONDO BEACH
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State | CA
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Zip | 90277-4904
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Country | US
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Telephone | 310-316-3577
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Fax | 310-316-3578
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Provider Business Mailing Address
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Address Line | 318 AVENUE I # 389
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City | REDONDO BEACH
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State | CA
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Zip | 90277-5601
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Country | US
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Telephone | 310-316-3577
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Fax | 310-316-3578
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | FRANK CROASDALE
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Credential | PT,DPT
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Telephone | 310-316-3577
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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 | PT17407
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License Number State | CA
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