Provider Demographics
NPI:1801431473
Name:MASADA, GARRETT (DPT)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:MASADA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 LADERA ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2125
Mailing Address - Country:US
Mailing Address - Phone:626-641-0179
Mailing Address - Fax:
Practice Address - Street 1:2123 FOOTHILL BLVD STE D
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2954
Practice Address - Country:US
Practice Address - Phone:909-596-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2976192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic