Provider Demographics
NPI:1891738639
Name:HAMIDI, MARYAM (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARYAM
Middle Name:
Last Name:HAMIDI
Suffix:
Gender:F
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 1:777 CORPORATE DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2136
Mailing Address - Country:US
Mailing Address - Phone:949-545-7007
Mailing Address - Fax:833-278-1932
Practice Address - Street 1:777 CORPORATE DR STE 160
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2136
Practice Address - Country:US
Practice Address - Phone:949-545-7007
Practice Address - Fax:833-278-1932
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24838174400000X
CA248382251G0304X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic