Provider Demographics
NPI:1689784944
Name:MODARRES SABZEVARI, MAHSA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MAHSA
Middle Name:
Last Name:MODARRES SABZEVARI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4188 PARK BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1255
Mailing Address - Country:US
Mailing Address - Phone:312-515-0495
Mailing Address - Fax:
Practice Address - Street 1:801 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3871
Practice Address - Country:US
Practice Address - Phone:925-945-6778
Practice Address - Fax:925-945-0389
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT336702251P0200X, 2251X0800X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist