NPIMap

Organization Active NPI

Jam Sports Inc

  • Physical Therapy Clinic/Center
  • North Hollywood, CA
National Provider Identifier
1962895805
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
37937 Issued in CA
Legal business name
JAM SPORTS INC
Practice address
12813 Victory Blvd
North Hollywood, CA 91606
Phone
(183) 924-9508
Fax
(323) 935-5933
NPI assigned
Mar 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Authorized official

Name
Dr. Joshua Abraham Mazalian, DPTNPI 1396024378
Title
Chief Executive Officer
Phone
(818) 392-4950

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 37937 CA Primary

Addresses

Primary practice location

12813 Victory Blvd
North Hollywood, CA 91606

Mailing address

12813 Victory Blvd
North Hollywood, CA 91606
Phone (818) 392-4950

Other names 1

  • Jam Sports and Spine Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160229001757 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8921303959 Receives reassigned benefits from 3 practitioners
Practice locations: Valley Glen, CA; Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

640 S San Vicente Blvd
Ste 284
Los Angeles, CA 90048
Phone (323) 470-9846

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1962895805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12813 VICTORY BLVD",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "91606",
            "telephone_number": "818-392-4950",
            "fax_number": "323-935-5933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12813 VICTORY BLVD",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "91606",
            "telephone_number": "183-924-9508",
            "fax_number": "323-935-5933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAM SPORTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-17",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "MAZALIAN",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "ABRAHAM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "818-392-4950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "37937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jam Sports and Spine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jam Sports and Spine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in North Hollywood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.