Provider Demographics
NPI:1104003193
Name:MALEKSAEEDI, ALI ASHGAR (DPT)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:ASHGAR
Last Name:MALEKSAEEDI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-6026
Mailing Address - Country:US
Mailing Address - Phone:310-490-5682
Mailing Address - Fax:310-310-2103
Practice Address - Street 1:2128 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-6026
Practice Address - Country:US
Practice Address - Phone:310-490-5682
Practice Address - Fax:310-310-2103
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT15924Medicare PIN