Provider Demographics
NPI:1083807143
Name:MOHABATAEEN, SEPIDEH (MPT)
Entity Type:Individual
Prefix:MS
First Name:SEPIDEH
Middle Name:
Last Name:MOHABATAEEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7854 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1701
Mailing Address - Country:US
Mailing Address - Phone:818-609-9035
Mailing Address - Fax:818-775-9135
Practice Address - Street 1:7854 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1701
Practice Address - Country:US
Practice Address - Phone:818-609-9035
Practice Address - Fax:818-775-9135
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist