MEDICARE: DREAMCARE PHYSICAL THERAPY SPORT AND WELLNESS

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

General Provider Information

NPI Number	:	1669153870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAMCARE PHYSICAL THERAPY SPORT AND WELLNESS

Provider Business Mailing Address
First Line	:	3626 KEYSTONE AVE APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-5624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3626 KEYSTONE AVE APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-5624
Country	:	US
Telephone Number	:	706-300-5710
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE OFFICER
Name	:	ASHKAN ASHKANI
Credential	:	DPT
Telephone Number	:	706-300-5710

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	09/26/2024

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Directions to “DREAMCARE PHYSICAL THERAPY SPORT AND WELLNESS ” Practice Location

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