Provider Demographics
NPI:1457741316
Name:KABIRI, VAHID (PT)
Entity Type:Individual
Prefix:
First Name:VAHID
Middle Name:
Last Name:KABIRI
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 1:26941 COLMENAR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3406
Mailing Address - Country:US
Mailing Address - Phone:949-484-3000
Mailing Address - Fax:949-215-4281
Practice Address - Street 1:26941 COLMENAR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3406
Practice Address - Country:US
Practice Address - Phone:949-484-3000
Practice Address - Fax:949-215-4281
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24232225100000X, 2251E1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT24232OtherPT LICENSE