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General NPI Number Information
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NPI Number | 1811358641
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Entity Type | Organization
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Legal Business Name | NATIONAL INSTITUTE OF RESTORATIVE EXERCISE
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 23504 LEYTE DR
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City | TORRANCE
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State | CA
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Zip | 90505-4524
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Country | US
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Telephone | 310-892-4376
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Fax |
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Provider Business Mailing Address
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Address Line | 23504 LEYTE DR
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City | TORRANCE
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State | CA
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Zip | 90505-4524
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Country | US
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Telephone | 310-892-4376
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. SCOTT W CHEATHAM
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Credential | PT
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Telephone | 310-892-4376
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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 | 29911
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License Number State | CA
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