Provider Demographics
NPI:1275135634
Name:KASSEBNIA, BIJAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BIJAN
Middle Name:
Last Name:KASSEBNIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 PORT ROYALE BLVD APT 618
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7855
Mailing Address - Country:US
Mailing Address - Phone:317-605-1786
Mailing Address - Fax:
Practice Address - Street 1:3101 PORT ROYALE BLVD APT 618
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7855
Practice Address - Country:US
Practice Address - Phone:317-605-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist