Provider Demographics
NPI:1689726960
Name:NABAVI, REZA (PT)
Entity Type:Individual
Prefix:MR
First Name:REZA
Middle Name:
Last Name:NABAVI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:REZA
Other - Middle Name:
Other - Last Name:NABAVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2696 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6362
Mailing Address - Country:US
Mailing Address - Phone:972-270-5555
Mailing Address - Fax:972-270-7071
Practice Address - Street 1:2696 N GALLOWAY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6362
Practice Address - Country:US
Practice Address - Phone:972-270-5555
Practice Address - Fax:972-270-7071
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D0305Medicare ID - Type Unspecified