Provider Demographics
NPI:1851986145
Name:OSTOVARI, PARISA (PTA)
Entity Type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:OSTOVARI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 ALTISMA WAY UNIT 115
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6311
Mailing Address - Country:US
Mailing Address - Phone:858-829-9946
Mailing Address - Fax:
Practice Address - Street 1:2306 ALTISMA WAY UNIT 115
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-6311
Practice Address - Country:US
Practice Address - Phone:858-829-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA49443225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant