Provider Demographics
NPI:1083366934
Name:POURNIA, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:POURNIA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:POURNIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:19700 MOONGLOW RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-1412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 KEARNEY ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3656
Practice Address - Country:US
Practice Address - Phone:510-524-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT301554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist