Provider Demographics
NPI:1518542992
Name:ASLANPOOR, SHIVA (PT DPT)
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:ASLANPOOR
Suffix:
Gender:F
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 1:5 JOURNEY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5330
Mailing Address - Country:US
Mailing Address - Phone:949-716-4548
Mailing Address - Fax:
Practice Address - Street 1:5 JOURNEY STE 100
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5330
Practice Address - Country:US
Practice Address - Phone:949-716-4548
Practice Address - Fax:949-271-2311
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist