Provider Demographics
NPI:1508492521
Name:SORAYA ROUDSARI PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:SORAYA ROUDSARI PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SORAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI-NIA ROUDSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-512-9157
Mailing Address - Street 1:2583 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1503
Mailing Address - Country:US
Mailing Address - Phone:408-512-9157
Mailing Address - Fax:
Practice Address - Street 1:2583 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1503
Practice Address - Country:US
Practice Address - Phone:408-512-9157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SORAYA ROUDSARI PHYSICAL THERAPY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-21
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty