MEDICARE: THE SPORTSMED COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1356439996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SPORTSMED COMPANY

Provider Business Mailing Address
First Line	:	1835 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4313
Country	:	US
Telephone Number	:	310-478-6222
Fax Number	:	310-478-6696

Provider Business Practice Location Address
First Line	:	1835 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4313
Country	:	US
Telephone Number	:	310-478-6222
Fax Number	:	310-478-6696

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRIAN JOSEPH HOHL
Credential	:	MPT
Telephone Number	:	310-478-6222

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	08/22/2020

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Directions to “THE SPORTSMED COMPANY ” Practice Location

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