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Organization
SKYFALL PHYSICAL THERAPY
Active
Organization
SKYFALL PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA KETTERHAGEN PT (PRESIDENT)
(310) 743-6649
Entity
Organization
Contact information
Practice address
11677 SAN VICENTE BLVD STE 207, LOS ANGELES, CA 90049-5128
(310) 743-6649
Mailing address
PO BOX 491471, LOS ANGELES, CA 90049-9471
(310) 743-6649
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/13/2017
Last updated
04/16/2021
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