Provider Demographics
NPI:1659998342
Name:AKRABOWON, JOE (PTA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:AKRABOWON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9983 STANWIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5204
Mailing Address - Country:US
Mailing Address - Phone:818-554-3647
Mailing Address - Fax:
Practice Address - Street 1:9545 RESEDA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2351
Practice Address - Country:US
Practice Address - Phone:818-886-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA50294225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty