Provider Demographics
NPI:1174718225
Name:MAGDY SARIELDIN
Entity type:Organization
Organization Name:MAGDY SARIELDIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SARIELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:909-599-0774
Mailing Address - Street 1:1111 W. COVINA BLVD
Mailing Address - Street 2:#100
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773
Mailing Address - Country:US
Mailing Address - Phone:909-599-0774
Mailing Address - Fax:909-599-8169
Practice Address - Street 1:1111 W COVINA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3205
Practice Address - Country:US
Practice Address - Phone:909-599-0774
Practice Address - Fax:909-599-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT7811Medicare PIN