MEDICARE: LIFESPAN PHYSIOTHERAPY STAFFING, INC

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	174400000X	Specialist	PT34535	CA
2	225X00000X	Occupational Therapist
3	261QP2000X	Physical Therapy Clinic/Center	PT34535	CA
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1578795688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESPAN PHYSIOTHERAPY STAFFING, INC

Provider Business Mailing Address
First Line	:	2941 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5901
Country	:	US
Telephone Number	:	619-888-5838
Fax Number	:	619-568-3313

Provider Business Practice Location Address
First Line	:	2941 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103
Country	:	US
Telephone Number	:	619-888-5838
Fax Number	:	619-568-3313

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ARMIN SHAVERDIAN
Credential	:
Telephone Number	:	858-412-9349

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	04/11/2023

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