1033438379 NPI number — SHAFA PHYSICAL THERAPY, SPORT INJURY AND REHABILITATION CENTER, INC.

Table of content: (NPI 1033438379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033438379 NPI number — SHAFA PHYSICAL THERAPY, SPORT INJURY AND REHABILITATION CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAFA PHYSICAL THERAPY, SPORT INJURY AND REHABILITATION CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1033438379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6597
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90212-6597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-777-7594
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11819 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE # 205
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-6619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-777-7594
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SHADROOZ
Authorized Official First Name:
DORIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PT
Authorized Official Telephone Number:
310-552-9575

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 34634 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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