Provider Demographics
NPI:1326054651
Name:MASSOUDI, HOSSEIN M (MPT)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:M
Last Name:MASSOUDI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1720
Mailing Address - Country:US
Mailing Address - Phone:510-526-8658
Mailing Address - Fax:510-526-8658
Practice Address - Street 1:801 EVELYN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1720
Practice Address - Country:US
Practice Address - Phone:510-526-8658
Practice Address - Fax:510-526-8658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist