Provider Demographics
NPI:1235483439
Name:GHOVANLOU, SHEILA (PT, MPT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:GHOVANLOU
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13836 BORA BORA WAY
Mailing Address - Street 2:APT 218
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6884
Mailing Address - Country:US
Mailing Address - Phone:916-715-0599
Mailing Address - Fax:
Practice Address - Street 1:13836 BORA BORA WAY
Practice Address - Street 2:APT 218
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6884
Practice Address - Country:US
Practice Address - Phone:916-715-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist