MEDICARE: ARLEN MINASSIAN PT

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	225100000X	Physical Therapist	34227	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34227	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1215103395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLEN MINASSIAN PT

Provider Business Mailing Address
First Line	:	3318 WEDGEWOOD LN
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-1668
Country	:	US
Telephone Number	:	818-438-8776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3318 WEDGEWOOD LN
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-1668
Country	:	US
Telephone Number	:	818-438-8776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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Directions to “ ARLEN MINASSIAN PT” Practice Location

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