Pico Athletic Club Inc
Organization Active NPI Physical Therapist · Los Angeles, CA
NPI 1730850652 · NPPES record last updated Sep 21, 2021
Key facts
- NPI
- 1730850652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- PICO ATHLETIC CLUB INC
- Practice address
- 8591 W Pico Blvd
Los Angeles, CA 90035-2412 - Phone
- (323) 934-2582
- NPI assigned
- Sep 21, 2021
- Organization subpart
- No
Authorized official
- Name
- Mrs. Kourtney Jamila-Adesuwa Vinolo
- Title
- Manager
- Phone
- (323) 934-2582
Practitioners 1
-
Johnnie Harrison, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240412002763 | CA | Part B Supplier - Clinic/Group Practice | 0648619478 |
Receives reassigned benefits from 1 practitioner Practice locations: Los Angeles, CA |
National Provider Directory
Locations
8591 W Pico Blvd
Los Angeles, CA 90035
Phone (323) 934-2582
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
8591 W Pico Blvd
Los Angeles, CA 90035-2412
Mailing address
8591 W Pico Blvd
Los Angeles, CA 90035-2412
Phone (323) 934-2582
Other providers in Los Angeles, CA
- Sharon Pickford
- Andrew Calvin Pickles
- Judith Carol Pickles
- Joseph D Pickman
- Brent Bowen Pickrell
- Pico Clinica Medica Latina, a Medical Group, Inc
- Pico Health Care Inc
- Pico Healthcare Inc
- Pico Medical Rents & Sells Inc
- Pico Square Pharmacy RX Inc
All providers in Los Angeles, CA · Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.