Provider Demographics
NPI:1417925728
Name:AMIRKHANIAN, VIVIAN (DPT)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:
Last Name:AMIRKHANIAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E STOCKER ST
Mailing Address - Street 2:#103
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1363
Mailing Address - Country:US
Mailing Address - Phone:818-802-8228
Mailing Address - Fax:
Practice Address - Street 1:840 APOLLO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4723
Practice Address - Country:US
Practice Address - Phone:310-606-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT320502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT320500OtherBLUE SHIELD
CAWPT32050AMedicare ID - Type Unspecified