Provider Demographics
NPI:1245511823
Name:SELECT PHYSICAL THERAPY AND REHAB, INC
Entity type:Organization
Organization Name:SELECT PHYSICAL THERAPY AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHEBBAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:818-912-7091
Mailing Address - Street 1:14624 SHERMAN WAY UNIT 404B
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2241
Mailing Address - Country:US
Mailing Address - Phone:818-912-7091
Mailing Address - Fax:818-884-8108
Practice Address - Street 1:14624 SHERMAN WAY UNIT 404B
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2241
Practice Address - Country:US
Practice Address - Phone:818-912-7091
Practice Address - Fax:818-884-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy