Provider Demographics
NPI:1497411573
Name:MAKAREMI, ARDAVAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ARDAVAN
Middle Name:
Last Name:MAKAREMI
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 1:21201 KITTRIDGE ST APT 8302
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-5038
Mailing Address - Country:US
Mailing Address - Phone:818-799-3500
Mailing Address - Fax:
Practice Address - Street 1:1934 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3957
Practice Address - Country:US
Practice Address - Phone:818-799-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist