Provider Demographics
NPI:1184830952
Name:BRAR, SHABNUM PURI (MPT)
Entity type:Individual
Prefix:MRS
First Name:SHABNUM
Middle Name:PURI
Last Name:BRAR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 ELKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2314
Mailing Address - Country:US
Mailing Address - Phone:818-723-8280
Mailing Address - Fax:
Practice Address - Street 1:18757 BURBANK BLVD STE 118
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6345
Practice Address - Country:US
Practice Address - Phone:818-812-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT289692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17215CMedicare PIN
CAGS714ZMedicare PIN