Provider Demographics
NPI:1013925544
Name:YOUSSEFIAN, ALEX M (PT)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:M
Last Name:YOUSSEFIAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 BRIGDEN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104
Mailing Address - Country:US
Mailing Address - Phone:626-797-9539
Mailing Address - Fax:661-678-4510
Practice Address - Street 1:390 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 2060
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4475
Practice Address - Country:US
Practice Address - Phone:626-394-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13737225100000X, 2251E1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic