Provider Demographics
NPI:1679543169
Name:SKYPARK PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:SKYPARK PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-373-5288
Mailing Address - Street 1:23332 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3749
Mailing Address - Country:US
Mailing Address - Phone:310-373-5288
Mailing Address - Fax:310-373-6223
Practice Address - Street 1:23332 HAWTHORNE BLVD
Practice Address - Street 2:BLDG #9, SUITE 202
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3749
Practice Address - Country:US
Practice Address - Phone:310-373-5288
Practice Address - Fax:310-373-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-6848Medicare ID - Type UnspecifiedPROVIDER NUMBER