Provider Demographics
NPI:1558013813
Name:SHOKRI, HOSSEIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:SHOKRI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:HOSSEIN
Other - Last Name:SHOKRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 HOYA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1283
Mailing Address - Country:US
Mailing Address - Phone:734-904-5361
Mailing Address - Fax:
Practice Address - Street 1:27700 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6426
Practice Address - Country:US
Practice Address - Phone:949-364-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT301514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist