Provider Demographics
NPI:1326080417
Name:PETOKIAN, ARTIN
Entity Type:Individual
Prefix:
First Name:ARTIN
Middle Name:
Last Name:PETOKIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ROLLING OAKS DR
Mailing Address - Street 2:STE 210
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1201
Mailing Address - Country:US
Mailing Address - Phone:805-446-3141
Mailing Address - Fax:805-446-3140
Practice Address - Street 1:325 ROLLING OAKS DR
Practice Address - Street 2:STE 210
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1201
Practice Address - Country:US
Practice Address - Phone:805-446-3141
Practice Address - Fax:805-446-3140
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT30056AMedicare ID - Type UnspecifiedMEDICARE ID NUMBER