Look up the most recent NPI and PECOS records

Sky Sport Spa

Physical Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

8500 Wilshire Blvd, Penthouse, Beverly Hills, CA 90211-3121

PECOS Enrollment

Based on the most recent information from CMS, provider Sky Sport Spa does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1396806378
Provider Type
Organization
Full Name
Sky Sport Spa

Subpart
No
Enumeration Date
12/13/2006
Last Updated
8/22/2020

Contact Information

Practice Location

8500 Wilshire Blvd, Penthouse, Beverly Hills, CA 90211-3121

(310) 652-7721

Unlisted Fax

Mailing Location

8500 Wilshire Blvd, Penthouse, Beverly Hills, CA 90211-3121

Unlisted Phone

Unlisted Fax

Authorized Official

Wadell, Jackie (Owner)

(310) 652-7721

Provider Taxonomies

Code	Description	License
Code 225100000X Primary	Description Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License PT19875 California

Sky Sport Spa

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Ton, Mimi P.

Evolutionary Motion Physical Therapy And Wellness, Inc.

Bolling, Stephanie

Banuelos, Raul

Joint Effort Medical Wellness

Higgins, Matthew

Avalos, Noel

Petkovich, Brooke

Kakita, Melia Nami

Reyes, Alex