Mark Anthony Sports LLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PT38186 Issued in CA

Legal business name

MARK ANTHONY SPORTS LLC

Practice address

112 S Catalina Ave
Suite 6
Redondo Beach, CA 90277-3384

Phone

(310) 801-8879

Fax

(866) 602-2994

NPI assigned

Oct 15, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Anthony Payares, DPT

Title

Owner

Phone

(310) 801-8879

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1225466964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 S CATALINA AVE",
            "address_2": "SUITE 6",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773384",
            "telephone_number": "310-801-8879",
            "fax_number": "866-602-2994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 S CATALINA AVE",
            "address_2": "SUITE 6",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773384",
            "telephone_number": "310-801-8879",
            "fax_number": "866-602-2994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK ANTHONY SPORTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-15",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "PAYARES",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-801-8879",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT38186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopedic Physical Therapist in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Orthopedic Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.