Provider Demographics
NPI:1629664834
Name:SAFAR, SHAYAN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:SAFAR
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 THREE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5546
Mailing Address - Country:US
Mailing Address - Phone:818-292-0010
Mailing Address - Fax:
Practice Address - Street 1:2226 THREE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5546
Practice Address - Country:US
Practice Address - Phone:818-292-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist