Provider Demographics
NPI:1154002483
Name:ENDURANCE PHYSICAL THERAPY A PROF CORP
Entity type:Organization
Organization Name:ENDURANCE PHYSICAL THERAPY A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & LEAD CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:THEOGENE LANDIS
Authorized Official - Last Name:BAQUET
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:310-773-7202
Mailing Address - Street 1:4589 VIA MARISOL UNIT 353
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5140
Mailing Address - Country:US
Mailing Address - Phone:310-773-7202
Mailing Address - Fax:
Practice Address - Street 1:695 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3249
Practice Address - Country:US
Practice Address - Phone:626-639-2808
Practice Address - Fax:626-489-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty