Provider Demographics
NPI:1417437823
Name:MEHYAR, JAMAL OMAR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:OMAR
Last Name:MEHYAR
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 1:32412 CROWN VALLEY PKWY APT 203
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3336
Mailing Address - Country:US
Mailing Address - Phone:360-339-2904
Mailing Address - Fax:
Practice Address - Street 1:24582 DEL PRADO STE C
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3820
Practice Address - Country:US
Practice Address - Phone:949-443-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-5903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist