Provider Demographics
NPI:1184384612
Name:PHYSICAL THERAPY 1ST REHABILITATION WELLNESS A PROFESSIONAL CORPOR
Entity type:Organization
Organization Name:PHYSICAL THERAPY 1ST REHABILITATION WELLNESS A PROFESSIONAL CORPOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARDAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAREMI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-799-3500
Mailing Address - Street 1:1934 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3957
Mailing Address - Country:US
Mailing Address - Phone:818-561-7707
Mailing Address - Fax:
Practice Address - Street 1:1934 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3957
Practice Address - Country:US
Practice Address - Phone:818-561-7707
Practice Address - Fax:213-724-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-24
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy