Provider Demographics
NPI:1356193882
Name:HATTAR, NASRI JEBRAN (PT)
Entity type:Individual
Prefix:DR
First Name:NASRI
Middle Name:JEBRAN
Last Name:HATTAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 E PARADISE VILLAGE PKWY S APT 1041
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7737
Mailing Address - Country:US
Mailing Address - Phone:914-536-2886
Mailing Address - Fax:
Practice Address - Street 1:33777 N SCOTTSDALE RD STE 110&115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1569
Practice Address - Country:US
Practice Address - Phone:480-595-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ033601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty