Provider Demographics
NPI:1053058271
Name:VERT SPORTS PT LP
Entity type:Organization
Organization Name:VERT SPORTS PT LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-264-8385
Mailing Address - Street 1:12400 SANTA MONICA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2522
Mailing Address - Country:US
Mailing Address - Phone:310-264-8385
Mailing Address - Fax:310-264-9076
Practice Address - Street 1:12400 SANTA MONICA BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2522
Practice Address - Country:US
Practice Address - Phone:310-264-8385
Practice Address - Fax:310-264-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty