Provider Demographics
NPI:1851866453
Name:SADEGHI AMINI, ARDALAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:ARDALAN
Middle Name:
Last Name:SADEGHI AMINI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28379 CAPTIVA SHELL LOOP
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-9064
Mailing Address - Country:US
Mailing Address - Phone:205-566-3365
Mailing Address - Fax:
Practice Address - Street 1:28379 CAPTIVA SHELL LOOP
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-9064
Practice Address - Country:US
Practice Address - Phone:205-566-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7162225100000X
225100000X
ALPTH9102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist