Sky Sport Spa

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT19875 Issued in CA

Legal business name

SKY SPORT SPA

Practice address

8500 Wilshire Blvd
Penthouse
Beverly Hills, CA 90211-3121

Phone

(310) 652-7721

NPI assigned

Dec 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jackie Wadell

Title

Owner

Phone

(310) 652-7721

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396806378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8500 WILSHIRE BLVD",
            "address_2": "PENTHOUSE",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902113121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8500 WILSHIRE BLVD",
            "address_2": "PENTHOUSE",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902113121",
            "telephone_number": "310-652-7721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKY SPORT SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WADELL",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-652-7721"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT19875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.