Provider Demographics
NPI:1205245792
Name:JARRAHZADEH, ANDRE KIAN (DPT)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:KIAN
Last Name:JARRAHZADEH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 NISSEN DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7704
Mailing Address - Country:US
Mailing Address - Phone:925-803-0530
Mailing Address - Fax:
Practice Address - Street 1:7800 SW DURHAM RD
Practice Address - Street 2:SUITE500
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7577
Practice Address - Country:US
Practice Address - Phone:503-937-0090
Practice Address - Fax:503-372-5191
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 41437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist