Organization
PERFORM 2 WIN PHYSIOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCO ANTONIO LOPEZ (CEO)
(323) 333-2943
Entity
Organization
Contact information
Practice address
601 CYPRESS AVE STE 402, HERMOSA BEACH, CA 90254-4645
(323) 333-2943
Mailing address
5353 LEDGEWOOD RD, SOUTH GATE, CA 90280-5344
(323) 333-2943
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2021
Last updated
01/22/2023
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