MEDICARE: PHYSICAL THERAPY 1ST REHABILITATION WELLNESS A PROFESSIONAL CORPOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1184384612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY 1ST REHABILITATION WELLNESS A PROFESSIONAL CORPOR

Provider Business Mailing Address
First Line	:	1934 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3957
Country	:	US
Telephone Number	:	818-561-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3957
Country	:	US
Telephone Number	:	818-561-7707
Fax Number	:	213-724-0277

Authorized Official
Title or Position	:	OWNER
Name	:	ARDAVAN MAKAREMI
Credential	:	DPT
Telephone Number	:	818-799-3500

Provider Enumeration Date	:	12/24/2021
Last Update Date	:	02/09/2022

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