Provider Demographics
NPI:1083738520
Name:BEBLAWI, CAROLE ADEL
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ADEL
Last Name:BEBLAWI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3036
Mailing Address - Country:US
Mailing Address - Phone:626-403-1444
Mailing Address - Fax:626-628-3905
Practice Address - Street 1:538 MISSION ST
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3036
Practice Address - Country:US
Practice Address - Phone:626-403-1444
Practice Address - Fax:626-628-3905
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 27047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist