Provider Demographics
NPI:1619222593
Name:JAVANSHIR-BEHROOZI, SAGHAR (PT)
Entity Type:Individual
Prefix:
First Name:SAGHAR
Middle Name:
Last Name:JAVANSHIR-BEHROOZI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SAGHAR
Other - Middle Name:
Other - Last Name:JAVANSHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4709 SEAFARER CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5467
Mailing Address - Country:US
Mailing Address - Phone:214-455-7572
Mailing Address - Fax:
Practice Address - Street 1:966 N GARDEN RIDGE BLVD
Practice Address - Street 2:SUITE 530
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2827
Practice Address - Country:US
Practice Address - Phone:972-420-6605
Practice Address - Fax:972-436-2770
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1069383OtherPT LICENSE