Provider Demographics
NPI:1982952347
Name:MADHAVAN, NAVEEN
Entity Type:Individual
Prefix:MR
First Name:NAVEEN
Middle Name:
Last Name:MADHAVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 W CARSON ST
Mailing Address - Street 2:APT 212
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3996
Mailing Address - Country:US
Mailing Address - Phone:310-739-5395
Mailing Address - Fax:
Practice Address - Street 1:1326 W CARSON ST
Practice Address - Street 2:APT 212
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3996
Practice Address - Country:US
Practice Address - Phone:310-739-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 8403225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant