Provider Demographics
NPI:1033438379
Name:SHAFA PHYSICAL THERAPY, SPORT INJURY AND REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:SHAFA PHYSICAL THERAPY, SPORT INJURY AND REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADROOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-552-9575
Mailing Address - Street 1:PO BOX 6597
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-6597
Mailing Address - Country:US
Mailing Address - Phone:310-777-7594
Mailing Address - Fax:
Practice Address - Street 1:11819 WILSHIRE BLVD
Practice Address - Street 2:SUITE # 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6619
Practice Address - Country:US
Practice Address - Phone:310-777-7594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty