Provider Demographics
NPI:1750640736
Name:MEDSTAR PHYSICAL THERAPY. INC.
Entity Type:Organization
Organization Name:MEDSTAR PHYSICAL THERAPY. INC.
Other - Org Name:MAJID SAEDIFAR, DPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEDIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-244-0009
Mailing Address - Street 1:610 N CENTRAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1403
Mailing Address - Country:US
Mailing Address - Phone:818-244-0009
Mailing Address - Fax:818-244-1703
Practice Address - Street 1:610 N CENTRAL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1403
Practice Address - Country:US
Practice Address - Phone:818-244-0009
Practice Address - Fax:818-244-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12100305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA199829805Medicare PIN