Provider Demographics
NPI:1245484658
Name:ROOSTAIAN, ABRAHAM K (PTA)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:K
Last Name:ROOSTAIAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 COMMONWEALTH LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-1245
Mailing Address - Country:US
Mailing Address - Phone:603-785-6314
Mailing Address - Fax:
Practice Address - Street 1:549 COMMONWEALTH LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34242-1245
Practice Address - Country:US
Practice Address - Phone:603-785-6314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21022225200000X
CA6693225200000X
FLPTA21022225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant