Organization
ADVANCED SPORTS MEDICINE & ORTHOPEDIC PT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANA MOLINA (ADMINISTRATOR)
(310) 416-9793
Entity
Organization
Contact information
Practice address
1200 ROSECRANS AVE STE 206, MANHATTAN BEACH, CA 90266-2451
(310) 416-9700
(310) 416-1120
Mailing address
1200 ROSECRANS AVE STE 206, MANHATTAN BEACH, CA 90266-2451
(310) 416-9700
(310) 416-1120
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT18890
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT18890
LICENSE
CA
Enumeration date
02/21/2007
Last updated
05/29/2020
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