Healthcare Provider Details

I. General information

NPI: 1811561061
Provider Name (Legal Business Name): PRO MOVE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 STANFORD RD
BURBANK CA
91504-2950
US

IV. Provider business mailing address

528 STANFORD RD
BURBANK CA
91504-2950
US

V. Phone/Fax

Practice location:
  • Phone: 818-642-6649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: NAEIRI KHACHKIAN
Title or Position: OWNER
Credential: DPT
Phone: 818-642-6649