Provider Demographics
NPI:1548046022
Name:BLOCH WELLNESS & SPORTS MEDICINE
Entity type:Organization
Organization Name:BLOCH WELLNESS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST/FLEXIBILITY COACH
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, SFC
Authorized Official - Phone:310-480-4052
Mailing Address - Street 1:6324 E PACIFIC COAST HWY STE C
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4841
Mailing Address - Country:US
Mailing Address - Phone:562-493-5600
Mailing Address - Fax:
Practice Address - Street 1:6324 E PACIFIC COAST HWY STE C
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4841
Practice Address - Country:US
Practice Address - Phone:562-493-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty