Provider Demographics
NPI:1396024378
Name:MAZALIAN, JOSHUA A (PT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:MAZALIAN
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 1:6320 COMMODORE SLOAT DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5453
Mailing Address - Country:US
Mailing Address - Phone:323-935-3420
Mailing Address - Fax:323-935-5933
Practice Address - Street 1:7658 SHOUP AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-5420
Practice Address - Country:US
Practice Address - Phone:702-788-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic