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Organization
SKY SPORT SPA
Active
Organization
SKY SPORT SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE WADELL (OWNER)
(310) 652-7721
Entity
Organization
Contact information
Practice address
8500 WILSHIRE BLVD, PENTHOUSE, BEVERLY HILLS, CA 90211-3121
(310) 652-7721
Mailing address
8500 WILSHIRE BLVD, PENTHOUSE, BEVERLY HILLS, CA 90211-3121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT19875
CA
Other
Enumeration date
12/13/2006
Last updated
08/22/2020
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