Provider Demographics
NPI:1891218350
Name:KOUCHAK, RAMTIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RAMTIN
Middle Name:
Last Name:KOUCHAK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RAMTIN
Other - Middle Name:AGHAKOUCHAK
Other - Last Name:ESFAHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7790 VIA TOSCANA
Mailing Address - Street 2:APT. 2308
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129
Mailing Address - Country:US
Mailing Address - Phone:916-220-9664
Mailing Address - Fax:
Practice Address - Street 1:7790 VIA TOSCANA APT 2308
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-5701
Practice Address - Country:US
Practice Address - Phone:916-220-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist