Healthcare Provider Details

I. General information

NPI: 1811623127
Provider Name (Legal Business Name): MONICA KHECHUMIAN PT, DPT, MPH, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 HAWTHORNE ST
GLENDALE CA
91204-1002
US

IV. Provider business mailing address

360 BURCHETT ST UNIT 6
GLENDALE CA
91203-1398
US

V. Phone/Fax

Practice location:
  • Phone: 818-482-8491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: