Provider Demographics
NPI:1043578396
Name:HAMIDI, SINA (PT)
Entity Type:Individual
Prefix:
First Name:SINA
Middle Name:
Last Name:HAMIDI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E COLORADO ST
Mailing Address - Street 2:UNIT 250
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1200
Mailing Address - Country:US
Mailing Address - Phone:818-246-5100
Mailing Address - Fax:818-246-3604
Practice Address - Street 1:815 E COLORADO ST
Practice Address - Street 2:UNIT 250
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1200
Practice Address - Country:US
Practice Address - Phone:818-246-5100
Practice Address - Fax:818-246-3604
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9766208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation