Provider Demographics
NPI:1245656032
Name:SADRPOUR, SHAHRZAD SOPHIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:SOPHIA
Last Name:SADRPOUR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHAHRZAD
Other - Middle Name:
Other - Last Name:SADRPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8717 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3216
Mailing Address - Country:US
Mailing Address - Phone:310-337-7115
Mailing Address - Fax:
Practice Address - Street 1:8717 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3216
Practice Address - Country:US
Practice Address - Phone:310-337-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 411352251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics