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Organization
SPORT CLINIC INC
Active
Organization
SPORT CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL LANCE LOPEZ PT (VICE PRESIDENT SERCETARY)
(510) 438-0294
Entity
Organization
Contact information
Practice address
39180 FARWELL DR, SUITE 101, FREMONT, CA 94538-1052
(510) 438-0294
(510) 438-0468
Mailing address
39180 FARWELL DR, SUITE 101, FREMONT, CA 94538-1052
(510) 438-0294
(510) 438-0468
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT18871
CA
Other
Enumeration date
07/15/2006
Last updated
03/18/2011
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