Provider Demographics
NPI:1720675598
Name:REZAEI, SEPEHR (DPT)
Entity Type:Individual
Prefix:DR
First Name:SEPEHR
Middle Name:
Last Name:REZAEI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:SEPEHR
Other - Middle Name:BRUCE
Other - Last Name:REZAEI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:5160 E PARKER ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-3615
Mailing Address - Country:US
Mailing Address - Phone:760-960-5777
Mailing Address - Fax:
Practice Address - Street 1:1594 S IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4241
Practice Address - Country:US
Practice Address - Phone:760-344-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist