Provider Demographics
NPI:1629602230
Name:DARBIDIAN, ANDRE BRANDON (DPT)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:BRANDON
Last Name:DARBIDIAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 MONTROSE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3600
Mailing Address - Country:US
Mailing Address - Phone:818-378-1228
Mailing Address - Fax:
Practice Address - Street 1:1000 N CENTRAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3685
Practice Address - Country:US
Practice Address - Phone:818-243-8422
Practice Address - Fax:818-243-8444
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty