Provider Demographics
NPI:1689365165
Name:REZAPOURIAN, SORIYA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SORIYA
Middle Name:
Last Name:REZAPOURIAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-7605
Mailing Address - Country:US
Mailing Address - Phone:330-787-2264
Mailing Address - Fax:
Practice Address - Street 1:8561 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6727
Practice Address - Country:US
Practice Address - Phone:330-953-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist