Provider Demographics
NPI:1326385592
Name:SEMAAN, JABBOUR S (PT)
Entity Type:Individual
Prefix:
First Name:JABBOUR
Middle Name:S
Last Name:SEMAAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 W GLENOAKS BLVD
Mailing Address - Street 2:204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1978
Mailing Address - Country:US
Mailing Address - Phone:480-309-1556
Mailing Address - Fax:818-956-0040
Practice Address - Street 1:1314 W GLENOAKS BLVD
Practice Address - Street 2:204
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1978
Practice Address - Country:US
Practice Address - Phone:480-309-1556
Practice Address - Fax:818-956-0040
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13519OtherLICENSE