Provider Demographics
NPI:1578795688
Name:LIFESPAN PHYSIOTHERAPY STAFFING, INC
Entity Type:Organization
Organization Name:LIFESPAN PHYSIOTHERAPY STAFFING, INC
Other - Org Name:LIFESPAN PHYSICAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAVERDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-412-9349
Mailing Address - Street 1:2941 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5901
Mailing Address - Country:US
Mailing Address - Phone:619-888-5838
Mailing Address - Fax:619-568-3313
Practice Address - Street 1:2941 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-888-5838
Practice Address - Fax:619-568-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34535174400000X, 261QP2000X
225X00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy