Provider Demographics
NPI:1629095286
Name:SHAHIDI, BITA (DPT)
Entity Type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:SHAHIDI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 YACHT CLUB WAY
Mailing Address - Street 2:#108
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2057
Mailing Address - Country:US
Mailing Address - Phone:424-400-5858
Mailing Address - Fax:310-536-0061
Practice Address - Street 1:2607 MANHATTAN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-1604
Practice Address - Country:US
Practice Address - Phone:424-400-5858
Practice Address - Fax:310-536-0061
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17215CMedicare PIN
CAFW882ZMedicare PIN