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General NPI Number Information
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NPI Number | 1922287259
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Entity Type | Organization
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Legal Business Name | WEST COAST SPORTS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 1137 2ND ST STE 103
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City | SANTA MONICA
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State | CA
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Zip | 90403-5069
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Country | US
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Telephone | 310-477-0018
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Fax | 310-954-9422
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Provider Business Mailing Address
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Address Line | 1137 2ND ST STE 103
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City | SANTA MONICA
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State | CA
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Zip | 90403-5069
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Country | US
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Telephone | 310-477-0018
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Fax | 103-954-9742
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Authorized Official
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Title or Position | OWNER
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Name | MR. RODNEY BUCHANAN
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Credential | PT
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Telephone | 310-416-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT 15886
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License Number State | CA
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